Senators Push to Open Database on Medicare and Controversy on Birthday of ED Healthcare Law

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Thu Apr 21 16:33:49 PDT 2011



April 8, 2011
Senators Push to Open Database on Medicare

Wall Street Journal
By Mark Schoofs and Maurice Tamman
 
Two senators have introduced legislation to overturn a 1979 court injunction that bars the government from revealing what individual physicians earn from Medicare.

That information is stored in the Medicare-claims database, widely considered one of the best tools for finding fraud and abuse in the $500 billion federal health-insurance program for the elderly and disabled.

Soaring Medicare costs threaten to overwhelm the federal budget, yet American taxpayers are blocked from seeing exactly where their money goes. Under a three-decade-old court order, Medicare can't publish the billings of individual physicians who participate in the program. In this series, The Wall Street Journal explores Medicare's vast databases and shows how they can be used to expose potential fraud and waste.

The Medicare Data Access for Transparency and Accountability Act, or DATA Act, was introduced Thursday by Sens. Ron Wyden (D., Ore.) and Charles Grassley (R., Iowa). They both serve on the Senate Finance Committee, which has jurisdiction over Medicare.

The Wall Street Journal, together with the nonprofit Center for Public Integrity, obtained from the government limited access to the database last year. Despite severe restrictions on using the data, the Journal was able to mine it and publish a series of articles exposing how doctors and other medical practitioners appear to be gaming Medicare to increase revenue.
One physical therapist identified by the Journal as having suspicious billing patterns, Aleksandr Kharkover, was indicted in February on charges of defrauding Medicare. He pleaded not guilty.

The judge who issued the 1979 injunction shielding the data ruled that physicians' privacy trumped the public's interest in knowing how tax dollars are spent. He relied on a privacy provision in the Freedom of Information Act, or FOIA. The new bill explicitly exempts physician Medicare billing data from that FOIA provision.

The legislation would also order the Department of Health and Human Services to make the data available at no cost. Patient identities would remain confidential.

Sen. Grassley, in prepared Senate floor remarks, cited articles in the Journal and said the bill "might deter some wasteful practices and overbilling."
Sen. Wyden, in prepared floor remarks, said "hiding" the data was "indefensible in a free society."

Last month, the Journal used the data to detect potentially negligent or harmful care. It identified an Oregon neurosurgeon, Vishal James Makker, who had an unusual propensity for performing multiple spine surgeries—as many as seven—on the same patients. Dr. Makker denied wrongdoing and said he acted in the best interests of his patients.

The American Medical Association, which opposes releasing physician-specific Medicare billing records, has argued that such data could be misused to erroneously assess quality of care.

Asked to comment, the AMA provided statements by its immediate past president, J. James Rohack, M.D., who said in part: "Medicare claims data alone cannot identify quality care, and the public release of Medicare claims data, without the complete medical record and due process, would often be misleading, inaccurate and disruptive to patients' longstanding relationships with their physicians."

In January, the publisher of The Wall Street Journal, Dow Jones & Co., filed legal papers to try to overturn the 1979 injunction in court and open the records fully to the public.

A spokesman for the Centers for Medicare & Medicaid Services, which administers Medicare, said it couldn't comment because of Dow Jones's legal action and because it doesn't comment on pending legislation.


 
 
April 11, 2011
Controversy remains on birthday of ED healthcare law. 

AMA Morning Rounds

In a Detroit Free Press (4/9) op-ed, James C. Mitchiner, MD, MPH, noted that by signing the "Consolidated Omnibus Budget Reconciliation Act on April 7, 1986, President Ronald Reagan and Congress gave legal imprimatur to a requirement that arguably ranks with the Civil Rights Act of 1964 as one of the most important anti-discrimination statutes ever enacted." Under the act, all individuals who present to the emergency department (ED) must have a "medical screening exam and, if an emergency condition or active labor is discovered," a specialist must provide care. While this may provide "needed relief for the uninsured," it has also "created headaches for hospital administrators, who must provide uncompensated emergency care to those without health insurance." Moreover, hospitals are not the only entities affected. A 2003 survey by the American Medical Association estimated that ED "physicians, on average, provided about $138,000 in uncompensated patient care annually, without any indemnification from patient lawsuits." 

 
 
 
Anna Parks &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service

 
 
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