The federal Medicare program is sitting on a trove of information that could help employers and patients decide which doctors provide the best service at the most reasonable cost. This is precisely the sort of information that President Bush has been urging the health care system to make available so that consumers can choose their doctors wisely. Yet the Department of Health and Human Services, relying on an old and dated court decision, has turned down a request for the data.
The conflicting perspectives were described by Robert Pear in yesterday's Times. The Business Roundtable, which represents 160 large companies, asked Medicare to release data on payments to individual physicians to help them determine which doctors achieved the best results — performing the most knee operations with the fewest complications and deaths, for example — and how the average cost per case differs from doctor to doctor.
Releasing the information would help insurance plans and employers decide which doctors to include in their networks. Properly scrubbed and evaluated, the information could also help patients choose their doctors.
To be sure, the raw data could be confusing. Individual doctors may have too few patients with a given diagnosis to yield trustworthy statistics, or their patients may be atypical; they may look good by one measure but bad by another. Medicare is running pilot programs to test releasing the data for physicians along with other measures of cost and quality, and it needs to be presented in ways that are fair to the doctors and useful to patients.
Federal health officials, however, feel constrained by a 1979 Federal District Court decision, which blocked the disclosure of Medicare payments to individual doctors as a violation of federal privacy laws. That case may no longer be relevant, given that reimbursement patterns have changed. But if necessary, Congress should amend the laws to allow disclosure.