Two months ago, I wrote about the conundrum HHS Secretary Mike Leavitt faced as a result of the decision in Consumers' Checkbook v. Leavitt. Faithful readers will recall that the federal court in this case ordered HHS to disclose to Consumers' Checkbook certain Medicare claims information. Consumers' Checkbook intended to publish that information to help consumers choose a care provider. As I noted, the Secretary had to decide whether to honor his commitment to a more transparent health care system or protect the privacy of physicians. He had to find the right balance.
Last month, the Secretary's position became a bit clearer, as the federal government filed a notice of its intent to appeal the Consumers' Checkbook decision. While we will not know the basis of the government's argument until legal briefs are filed, the notice of intent is enough to recognize that the Secretary's commitment to transparency is not absolute. After all, Leavitt simply could have decided to not appeal. He could have opted to make the Medicare physician data available. But that is not the course that has been chosen.
Which prompts this question: Does it really matter?
From a legal perspective, you bet it does. But from the perspective of an information-driven health system, maybe not so much.
The issues at hand in Consumers' Checkbook all involve the Freedom of Information Act -- the primary thrust of which is not about privacy, but rather about the right of the citizenry to know what the federal government is up to. Still, FOIA does not require disclosures of federal information that would "constitute a clearly unwarranted invasion of personal privacy." The trial court found that releasing the Medicare information would not result in an "invasion of personal privacy." We will have to wait and see if that is the last word or if the appellate courts (this one could go to the Supreme Court) will have a different view. One way or the other, the courts will clarify how these competing interests -- providing consumers with Medicare information to assist in selecting a physician versus the privacy rights of those physicians -- are to be balanced.
However, given the degree to which the health care system is increasingly benefiting from and driven by information, physician-specific performance information will increasingly be available and used by consumers. Similarly, employers, government and insurers will use that same information to build their provider networks and to reward high-performing physicians.
Of course, there have been a number of sources for specific physician information. HealthGrades has been making information about physicians available online (and at a cost) for some time. Information available on the site includes board certification, disciplinary action, education and, more recently for some physicians, performance assessment information from Bridges to Excellence.
The National Council for Quality Assurance, long in the business of assessing health plan performance, now has begun to assess physician performance in the areas of diabetes care, care of patients with back pain, and care provided to patients with cardiovascular disease or who have had a stroke.
Meanwhile, a recent and very interesting effort is being launched by Wellpoint and Zagat. Yes, that's right, Zagat, the source for insightful reviews and critical commentary on restaurants. As anyone who has visited Zagat.com knows, those reviews and comments are distilled from the experience of individuals dining at the restaurant.
Now, Wellpoint and Zagat are teaming up to do for health care consumers what Zagat has done for those looking for a particular dining experience. Wellpoint members will be able to assess physicians in Wellpoint's network with regard to trust, communication, availability and environment using a 30-point scale. Members also will be able to share information on each physician in a comments section.
While no quality of care information will be provided though the Zagat/Wellpoint site, it is widely recognized that a patient's experience in receiving care is predictive of overall performance. By giving Wellpoint members access to the views and experiences of their peers, the company is rolling out a "critical component of [its] consumer engagement strategy," according to a release from the group.
All of this, and a good deal more, is happening without the benefit of government data. And more information, and more useful information, will come as physicians and other providers begin to use National Provider Identification numbers. Under HIPAA, providers are required to use NPIs beginning March 1, 2008. These standardized, unique identification numbers initially were envisioned as a way to realize new levels of administrative simplicity and efficiency.
We can all see how one number per provider will allow the health care financing and administrative system to work better, and it doesn't require a great leap to see how all sorts of valuable information regarding provider and physician performance will result from NPI implementation. For those who have explored Google Maps, think about the power of an NPI "mashup." While I expect all readers of iHealthBeat are familiar with mashups, those who are generationally limited might better understand by considering this Wikipedia definition: "a mashup is a Web application that combines data from more than one source into a single integrated tool; an example is the use of cartographic data from Google Maps to add location information to real estate data from Craigslist, thereby creating a new and distinct Web service that was not originally provided by either source." Got it?
By using a physician's NPI, data integrators and tech savvy patients will be able to knit together what has heretofore been disparate, disconnected data, permitting a complete and comprehensive view of the performance of individual physicians (or groups, or institutional providers for that matter). BTE and NCQA performance data will be able to be merged with Zagat consumer experience data, HealthGrades data and maybe even government data to allow consumers, purchasers, researchers, regulatory authorities and pretty much anyone else to really understand how providers compare and, more importantly, why some are high performing and others are not.
The possibilities of an information-driven health care system are pretty exciting and critically important as the nation and its health care system braces for the demographic, clinical and economic demands that are just over the horizon. The privacy issues, those that arise under FOIA and others yet to be asserted, must be taken seriously. We will all demand that. But we also will demand that the powerful information be available to us in making our health care decisions. Just like Leavitt, we will collectively have to find the right balance.