Private insurers have given their data, so now where is the Medicare data?

I wrote yesterday about the consumer information tools being provided by innovative health plans. Some of these include quality comparison and report card tools, cost calculators, etc. Clearly one of the most obvious limitations in these tools is the validity of the data being presented. To date, much of this data is coming from a limited sample of health plan data.

According to the Centers for Medicare and Medicaid Services (CMS), Medicare represents 16.5% of healthcare expenditures in 2004. This data would be dramatically improve the data quality underlying these consumer tools and calculators.

The New York Times article, “Employers Push White House to Disclose Medicare Data” describes the efforts by national employer groups such as the Business Roundtable to push CMS to release this data.

“President Bush has repeatedly urged private insurers to disclose such data, saying it will help consumers choose doctors and hospitals. But Medicare, the nation’s largest insurer, has turned down a request for its data from the Business Roundtable, whose member companies provide coverage to more than 25 million people.”

The article also describes all the “red herrings” that CMS claims as to why they can’t disclose this data.

First, there are privacy issues from a 1979 court ruling:

“Administration officials said they shared the employers’ goals, but were constrained by court rulings that limited the disclosure of data showing Medicare payments to individual doctors, identified by name. Employers disagree, saying those court rulings are no longer relevant… A spokeswoman said that the administration is reviewing that decision.”

Second, CMS has said that the claims database is so large, with over a billion claims per year, that they can’t produce a file of more than 5% of claims. This reason sounded like the most ridiculous excuse to me. So can someone explain to me why they can’t produce 20 files with 5% each? I’m sure that this issue can be addressed.

This administration should follow the proverbial saying, “put up or shut up!” It’s time for CMS to release its data so that patients and payers can make better decisions with better information on healthcare cost and quality.

April 13, 2006

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