Each year, millions of consumers nationwide turn to Consumer Reports for independent, unbiased tests of consumer goods or services such as cars, appliances, electronics, food and financial services. Publishing these independent findings helps consumers make smart buying decisions and prompts manufacturers to remove dangerous defects and improve the quality and performance of their products.
But when it comes to healthcare, consumers do not have nearly the same access to information that would help them make informed choices about picking a particular doctor or hospital. Without such information, healthcare providers are not subject to the same level of public scrutiny that would motivate them to deliver safer and more effective care.
That could change if the U.S. Court of Appeals for the District of Columbia Circuit in Washington affirms that HHS must make public much of its vast database on the care provided to Medicare beneficiaries.
In the case before the court, the not-for-profit Consumers Checkbook requested data on doctors such as diagnosis and procedure codes from a database of Medicare claims. (Consumers Checkbook, which is a project of the Center for the Study of Services, is not related to Consumers Union.) Medicare is the nations largest insurer, with over 43 million beneficiaries and more than a billion claims per year. The Medicare database of claims for doctors and hospitals services provides one of the best objective sources for independent research and unbiased analysis of quality and performance.
The data sought by Consumers Checkbook would show, for example, which doctors performed the most heart operations or hip replacements with the fewest complications. Consumers could use such comparisons as a piece of the total picture to help them choose doctors who achieved the best results. The data did not include any information identifying Medicare patients.
HHS refused to provide the data that would enable Consumers Checkbook to identify and evaluate which doctor performed the services and the results, claiming that this would constitute a clearly unwarranted invasion of the doctors personal privacy.
From the consumers perspective, healthcare, cars and appliances are all core goods and services in the marketplace. Of course, evaluating a service can be more complex than assessing a product, and medical services are no exception. Nonetheless, consumers have a right to evaluate and compare individual doctors and hospitals before making these important choices. While databases exist on quality of care, most do not publicly disclose the results by doctor or hospital. The agencys response is equivalent to allowing Consumer Reports to rate cars but prohibit disclosing which car had the poor quality and which had the excellent value. In both cases, the consumer lacks the essential information needed to make an informed choice, and there is no public accountability for the manufacturer or doctor or hospital to correct poor quality or dangerous goods and services.
The stakes are high, and the consumer and national benefits of disclosure are indisputable. Americans spent more than $1.3 trillion in 2006 on personal healthcare by hospitals, doctors and related professionals. This represented approximately 10% of Americas gross domestic product. Evaluating the quality and performance of those hospital and doctor services is critical.
Moreover, Medicare funds are public funds. In 2006, the federal government spent more than $290 billion for personal healthcare by hospitals and professionals. Enabling Americans to check ratings of a particular doctor or hospital before a first visit or an important operation will spur improvements in care and ultimately make sure that taxpayer dollars are spent wisely.
And for all of the small and large employers nationwide that purchase healthcare, the stakes are just as high and the benefits just as important as for the individual consumer.
We know firsthand the value that publicly available comparative data have in improving the safety, performance, and value of products and services. In our 70-year experience, it is clear that transparency is a critical hallmark of a high-functioning and responsive marketplace. The raw Medicare claims data hold critical information for patients and other key stakeholders looking to make the best healthcare decisions comparing physicians and hospitals performance.
As Justice Louis Brandeis once said, Sunlight is said to be the best of disinfectants.
The case is Consumers Checkbook, Center for the Study of Services v. United States Department of Health and Human Services, pending in the U.S. Court of Appeals for the District of Columbia Circuit. The Court of Appeals will hear the case on Oct. 8. Consumers Union, the not-for-profit publisher of Consumer Reports, filed a friend-of-the-court brief in the case.