HHS appeals court order to give claims data to consumer groups

The department said it supports health care transparency but has been unable to reconcile the ruling with a conflicting past court opinion on the issue.

By David Glendinning, AMNews staff. Dec. 10, 2007.

Washington -- The Dept. of Health and Human Services is appealing a court order that it release Medicare physician claims data to a consumer group.

The HHS appeal in late October blocks for now a plan by Consumers' Checkbook/Center for the Study of Services to use the claims data to provide patients with more detailed information about the quality of physician care. The nonprofit organization had planned, as a first step, to create a free online public resource listing how many times in one year individual physicians had performed certain Medicare procedures in the District of Columbia and the four states covered by the order: Illinois, Maryland, Virginia and Washington.

A patient who needed a knee replacement, for instance, might use the guide to pick a doctor who has performed a significant number of these surgeries under the assumption that the physician would be more likely to provide high-quality care than one who rarely provided the service.

Consumers' Checkbook/CSS had sued HHS for the physician claims data and successfully argued before the U.S. District Court for the District of Columbia that the potential consumer benefits of the information outweighed the "minimal" privacy intrusion to doctors that would result. The department appealed the Aug. 22 decision to the U.S. Court of Appeals for the District of Columbia, and the original order has been stayed pending the appeal's outcome.

The district court's assessment fails to acknowledge that the action would amount to an indiscriminate release of raw Medicare claims data, wrote AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, in a Sept. 14 letter urging HHS to appeal the order.