AMA Sues to Keeps Medicare Claims Data Private

Posted on February 12, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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AMA Wins Appeal to Blind Consumers’ Checkbook

[By Dr. David Edward Marcinko; MBA]human-drones

The Centers for Medicare and Medicaid Services [CMS] does not have to turn over physician-specific Medicare claims data requested by not-for-profit Consumers’ Checkbook under the Freedom of Information Act, the U.S. Circuit Court of Appeals for the District of Columbia ruled in an opinion delivered January 30th.

AMA and DHHS

According to Gregg Blesch of Modern Healthcare, on 2/2/09, the American Medical Association [AMA] joined the Department of Health and Human Services [DHHS] in appealing a 2007 decision that the data should be subject to disclosure, but the appeals court concluded the physicians’ privacy interest outweighs the consumer group’s assertions that the data would be used in the public interest.

Three Decade DHHS Legal Conundrum

DHHS, meanwhile, was not concerned so much with privacy as with its own legal conundrum involving a 1979 federal injunction barring the release of Medicare data that identifies individual physicians. A 2008 statement explaining the decision to appeal said the department “recognizes and shares the goals of Consumers’ Checkbook” and was seeking a legal way for the government to share Medicare claims data as part of its own quality initiatives.

Link: http://www.ama-assn.org

About Consumer’s Checkbook

Consumers’ Checkbook/The Center for the Study of Services is an independent, nonprofit consumer organization founded in 1974 with the help of funding from the U.S. Office of Consumer Affairs. Its’ purpose is to provide consumers information to help them get high quality services and products at the best possible prices. The organization is supported entirely by subscription payments and donations from individual consumers who subscribe to its magazines, and by fees for surveys, and information services and books. They do not accept donations from businesses and their publications carry no advertising.

Link: http://www.checkbook.org

About the AMA

The home page of the AMA website states the organization is “helping doctors help patients.”  Is this really the case; or mere rhetoric? Is it true that less than 20% of the nations MDs are members?

Assessment

Consumers’ Checkbook said it would use the data to show the frequency with which physicians performed certain procedures; expose how much Medicare pays physicians who have disciplinary histories or poor evaluations; and determine whether they were fulfilling standards of recommended care. The court found each argument wanting.

Industry Indignation Index Rating: 85

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6 Responses

  1. Dexter, on February 12, 2009 at 4:21 PM said:

    AMA Sues Cigna and Aetna

    On February 11, 2009 the American Medical Association joined several state associations in suing health insurers Cigna Corp., of Philadelphia, and Aetna Inc. over a database they say was rigged to underpay doctors on out-of-network claims for more than a decade.

    According to the report, doctors want compensation for the time they wasted asking the insurers for more money, for income they lost because of the low payments and for the inability of patients to pay their share of the bills.

    Patients who use doctors who are not in their insurance company’s network typically are expected to pay whatever the insurer doesn’t because of low payments that leave patients with larger bills.

    Cigna and Aetna, of course, suggest high doctor charges were part of the problem.

    Dexter

    Like

  2. Adam, on February 17, 2009 at 2:12 PM said:

    Hi Dexter,

    According to the AMA News, February 16, 2009, the AMA called this ruling a “major victory” for preserving physician privacy and for protecting patients who otherwise could have received bad data.

    With about a 22-23% MD membership penetration; what a way to … parse!

    Adam

    Like

  3. Dr. Joe, on August 6, 2010 at 2:14 PM said:

    Is the AMA Credible?

    Let’s face it, The American Medical Association, is no longer a genuine national physician association, if it ever was. Indeed, last year’s reform debate exposed, and aggravated, the AMA’s growing credibility problem with American physicians.

    http://www.physicianspractice.com/career/content/article/1462168/1628410

    So, is social network Sermo the new defacto national society for physicians?

    Dr. Joe

    Like

  4. Marvin, on December 7, 2013 at 6:48 AM said:

    The AMA

    This doctor quit the AMA and his state medical society.

    http://www.kevinmd.com/blog/2013/12/doctor-quits-ama-state-medical-society.html

    What about you?

    Marvin

    Like

  5. Dr. Joe, on September 30, 2014 at 3:28 PM said:

    Open Payments website launch has physicians and industry reps on edge

    http://www.physiciansnews.com/2014/09/30/health-law-will-reveal-drug-company-payments-to-doctors-today/?utm_source=Copy+of+9.24.14&utm_campaign=11713&utm_medium=email

    Today’s launch of the Open Payments website has trade and physician associations worried about the accuracy and presentation of the data.

    http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/launch-open-payments-website-has-industry-and-physician-association

    But, The government’s new website on drug and device company ties to doctors will be incomplete and may be misleading – for now.

    http://www.propublica.org/article/what-to-be-wary-of-in-the-govts-new-site-detailing-industry-money-to-docs?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter

    Dr. Joe

    Like

  6. Ann Miller RN MHA, on July 9, 2016 at 6:46 PM said:

    CMS’ Open Payments Program Posts 2015 Financial Data

    The Centers for Medicare & Medicaid Services (CMS) has published the 2015 Open Payments (sometimes called the “Sunshine Act”) data, along with newly submitted and updated payment records for 2013 and 2014, at https://openpaymentsdata.cms.gov. The Open Payments program requires that transfers of value by drug, device, biological, and medical supply manufacturers to physicians and teaching hospitals be published on a public website.

    In program year 2015, healthcare industry manufacturers reported $7.52 billion in payments and ownership and investment interests to physicians and teaching hospitals. This amount is comprised of 11.90 million total records attributable to 618,931 physicians and 1,116 teaching hospitals.

    To find out what any doctor received in 2015, click here.
    https://openpaymentsdata.cms.gov/

    Source: CMS

    Like

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