Secrecy Stunts Market-Based Healthcare Reforms

Medicare's release of physician payment data holds great potential for the industry's shift toward value-based payments. While medical associations are opposed to pay transparency, one physician explains why he supports it.

"When it comes to privacy and accountability, people always demand the former for themselves and the latter for everyone else." – novelist and futurist, David Brin

Transparency is a prominent panel in the patchwork quilt of federally driven healthcare reform efforts across the country. In particular, transparency in billing for medical services is widely viewed as a critical component in establishing a value-based US healthcare system.

The logic is compelling: Informed patients will seek out physicians who provide high-quality medical services at the lowest cost, informed physicians will use data to improve the efficiency of their practices, and informed health plans will apply pressure to healthcare providers who fall short of providing value to their patients.

But last week, the American Medical Association, Medical Group Management Association, and other physician groups blasted federal officials over the release of Medicare physician payment data that had been kept secret under a court injunction since 1979. The justification for keeping the data secret included this dire warning—payment confusion would spread throughout the land and careers would be unjustly destroyed.

AMA President Ardis Dee Hoven, in a statement released by her organization, made clear why she's opposed to the Medicare data dump, "releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions, and other unintended consequences."

Secrecy is at Odds with Reform
Few black-and-white statements can be made about reforming the delivery of healthcare in the United States. The issues are complicated and US healthcare is a sprawling industry that directly impacts more than 300 million people.

But when I was reporting last week's release of the Medicare physician payment data, California-based cardiologist Earl Ferguson, MD, PhD, shared a clear-cut truth with me: "This is just one step," he said. "We need to have a lot more transparency in government and health plans. We can't keep everything secret if we're going to reform the system."

Nowadays, doctors are a grumpy lot. No one likes being placed under tighter scrutiny or seeing their business' costs outpacing revenue, which is what makes Ferguson's perspective so precious.

Soon after I joined the HealthLeaders staff in January, the California cardiologist was among my first physician interviews. He had recently published a book on US healthcare reform and his passion is palpable. Ferguson is not only fighting to reform the country's healthcare delivery system, he is committed to saving a noble profession.

'Find Out What's Rational'
When we talked last week, I could tell the good doctor was hesitant to break ranks with the AMA over the release of the Medicare physician payment data. But for Ferguson and a growing legion of physicians who are willing to enter the political fray to fight for what they feel is right, conscience trumps self-interest.

"We really need to start looking at this data," he told me. "We need to get all these people together and find out what's rational, rather than having bureaucrats and others making decisions for us."

The Medicare physician payment data released last week provides claims information for 880,000 physicians. The data includes the types of procedures doctors perform and the volume of services. "[This type of] information will be invaluable to people," Jennifer Schneider MD, vice president of analytics at San Francisco-based Castlight Health, told me last week.

Although she dislikes the term "Big Data," Schneider says the Medicare physician payment information's full transparency potential will be realized when researchers combine it with other databases.

"The release of this information and the overlay of other information becomes really powerful," she told me, noting that the Medicare data could be combined with commercial payer claims to create a more complete financial picture of a physician's practice.

As the courts and lawmakers tackle releasing more information about physicians, health plans and other healthcare system stakeholders, I hope they are guided by Ferguson's undeniable truth: "We can't keep everything secret if we're going to reform the system."