U.S. Court of Appeals for D.C. Thwarts Access to Morbidity/Mortality Findings
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The consumerist group, Consumers’ Checkbook/Center for the Study of Services won its lawsuit in 2007 forcing the Dept. of Health and Human Services to release Medicare claims data which would have allowed researchers to determine the frequency with which physicians in several states performed certain procedures, and what results were achieved, according to today’s Medical News Today. The information would have helped health insurers evaluate physician quality, and would have allowed consumers to make better-informed decisions on which physicians to use, since the information was to have been posted on the internet for public viewing.
But, the U.S. Court of Appeals for the District of Columbia reversed that decision (of the U.S. District Court for the District of Columbia) last week, finding that the FOIA (Freedom of Information Act) had been improperly utilized below. “Accordingly,” wrote Judge Karen LeCraft Henderson, “we need not balance the nonexistent public interest against every physician’s substantial privacy interest in the Medicare payments he receives.”
I guess Judge Henderson hadn’t bothered checking in with me before writing her decision. Maybe next time.
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throckmorton said:
One issue that this case brings up is “how is quality in hospitals measured and reported”. This case was about reviewing Medicare claims. It was not a review of what actually happened during the surgeries or the care. When you look just at claims data, there is no understanding of the actual medical care. Here is an example. Doctor A only performed 50 of a certain procedure and the same patient had claims for these other diagnosis that may or may not be related to the surgery. By this data he did fewer of the cases and had possibly more complications. What the data does not show is that Doctor A is at the referral center and only sees the sickest of the patients that have been bypassed by other physicians. In reality, Doctor A is the best as he is who other surgeons send the hardest cases to.
We need a good way to effectively understand, manage and ensure quality. We used to do this through hopital peer review. This process is all but gone as in some states, this peer review is discoverable and can lead to lawsuits. In other states there is fear that this will later become discoverable and lead to suits. As a result, complications are not formally investigated or reviewed.
February 6th, 2009 at 6:26 am