Doctors are split on the value of transparency
September 01, 2013
At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.
An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.
September 01, 2013
Some additional news regarding the Medicare Physician data: Healthcare IT News reports that the medical community is split on whether the data should be released. As expected, some physicians "said the data is too easily misinterpreted by the public and could be used to portray physicians in a negative and unfair light" -- which strikes me as a classic way of saying that consumers are not saavy enough to benefit from increased transparency. Rather than hiding behind vague possibilities, why not educate the industry on how interpretation of the data could actually go wrong? Better yet, rather than condescendingly dismiss the value of such data, why not release data that they do think is important?
I am hopeful that Medicare will choose to release this information, and if so, I think some organizations can help consumers better figure out which providers to see. Obviously, there will be many other benefits, including increased transparency and fraud detection. If the opponents are right that this data proves to not be useful, it's hard to imagine the data having much of a negative effect. After all, when has increased transparency had significant harmful effects in the long-term? If you haven't already responded to the Department of Health and Human Services' request for public comment, you still have a few days to let them know what you think.
August 24, 2013
A couple of weeks ago, I noted that HHS invited public comment on the proposal to release Medicare Physician Data. If you haven't done so yet, you still have a couple of weeks. Below is the comment that I submitted.
To The Department of Health and Human Services:
I applaud HHS's release of data in machine-readable form. The release of Medicare Physician Data would be the most revolutionary large-scale physician database that I have yet to see. For example, with the release of claim information, a person who needs a rare surgery can finally search to see which providers have performed that surgery before (at least, which providers have done so for Medicare). Closer to home, the pricing information might have gone a long way earlier this year in helping my family figure out which doctors to approach when someone needed to undergo a specific procedure.
In regards to the questions,
1) It would be the prerogative of any insurer (whether public or private) to release claims data unless they specifically bound themselves with confidentiality agreements. Additionally, considering that government employee salaries are public information and that government payments to contractors are generally disclosed, withholding Medicare payment data would be an odd exception. The public benefit of releasing Medicare information is immense. First, the sheer volume of data from the nation's largest payer would give the public tremendous insight into health care practices. Second, the release of this data creates a powerful example for private insurers to emulate: empowering their customers with useful information when selecting a provider. Any privacy concerns must be weighed against this potential of catalyzing the next generation of tools that could transform the health care industry.
2) CMS should be as open as possible and release as much information as it legally can without encroaching on patient privacy. To add limitations is to limit the innovative uses of this data. Even seemingly unimportant details such as dates of claims can be used to help the public understand when certain conditions tend to occur, or to help provider institutions better allocate their resources on a seasonal basis. Physicians can also use procedure volume information to make more informed referrals.
3) CMS should release the data in as detailed form as possible (e.g. line item claim details). The data should identify physicians by their National Provider Identifiers, include the date of the procedure, the procedure name and code, the condition for which the procedure was prescribed, and the address where the procedure was performed. Presenting claim-level data is important because it would be helpful, for example, to know which procedures are being applied to which conditions. Observing such relationships can be instrumental in detecting fraud, but presenting the data in aggregate form would obscure such relationships. Researchers and others can aggregate data themselves; they cannot reverse the process, so only releasing aggregate data will limit innovation. Patient privacy can be protected by combining records for specific procedures into one line when there are less than five occurrences for a provider in a given year. It would be helpful for the data to be catalogued by individual calendar years or quarters for ease of downloading.
Although not an immediate priority, it would be helpful for CMS to automatically translate CPT codes to codes from an open code set (e.g. SNOMED). After all, one of the same organizations that lobbied so hard to keep this information private owns the CPT code set and might come up with creative ways of restricting usage of the data.
I am encouraged by the increasing availability of physician information over the last few years, and the release of Medicare Physician Data will greatly advance transparency in health care. Empowered by better information, patients will be able to take the next step in making decisions for a higher-quality and more efficient health care marketplace.
In anticipation of a brighter health care future,
Jerry Lin
August 18, 2013
DocSpot's mission is to help patients make better health care decisions. A big part of this is to increase transparency by bringing together information from a variety of sources. While we're obviously happy when people use our site to make an informed decision about which providers to see, not everyone knows about our site. So, in some cases, we partner with other sites to help their users.
Castlight Health recently announced our partnership with them. We think they are doing a lot to expand the frontier of patient empowerment and we are glad to be working with them. Hopefully, as consumers get more and more options, they will have an easier time making better decisions for their health.
August 09, 2013
Amidst a national debate about health care costs, a branch of the government tried to shine a light on how much Medicare was paying. A state association of doctors fought to keep the information private. The doctors' association won. The decade? The 1970s.
Over thirty years later, amidst another debate on health care costs, the 1979 injunction was vacated when different parties (including The Wall Street Journal) asked the judicial system to overturn its previous decision. The court's decision paves the way for Medicare to release its claims database.
This is a momentous occasion -- over three decades in the making. The claims database represents a treasure trove for researchers, as well as a potent weapon against fraud and abuse. For our purposes, we recognize that this database can be extremely helpful for patients selecting a physician. For example, using the data, patients should be able to tell which doctors in their area have performed a specific procedure for Medicare.
The Department of Health and Human Services, however, is not quite ready to release the database. Instead, it's issued a Request for Public Comment. If you care about increased transparency and being able to find the right physician, I encourage you to let Medicare know.
August 04, 2013
DocSpot has been under development for over four years, and a central challenge has been getting access to meaningful data to help people make better health care decisions. Pricing information in particular has been rare. Over the years, we've witnessed some changes. One recent example is Medicare's posting of pricing information. Another example mentioned in the news last month is how some providers in Oklahoma have been posting surgery prices.
This shift in mentality makes sense -- as Americans continue to fret over rising health care premiums, patients are increasingly asked to bear more of the costs of medical care. As more and more people pay out of their own pockets, demand for lower-cost services increases. Some providers respond by advertising their lower prices. Obviously, we'll continue to have high-cost providers for a long time (people continue to associate high prices with high quality and changes in the health care industry happen much more slowly than in some other industries), but we're encouraged by the initial signs of an industry changing to become more transparent.