By SEN. CHUCK GRASSLEY and SEN. RON WYDEN | 7/28/13
For no compelling reason, a commanding tool for trying to contain health care costs is lying unused. That sidelined powerhouse is the Medicare claims database, which holds a record of all payments from taxpayers to physicians and other providers for seniors’ health care.
If bipartisan legislation now before the Senate becomes law, this information would be made available to all Americans through a free, searchable online database. It would instantly position Americans to secure more value for the $2.7 trillion being spent this year on health services. That’s because the publication of the Medicare data will become health care’s new financial baseline; the measure of what America’s largest and most powerful buyer of health care gets for nearly $600 billion a year.
Today, free access to the Medicare database is limited to a small number of bureaucrats and academics despite a federal judge’s recent ruling in favor of greater public access. If the public, press or watchdogs want this information, they must try to wade through the federal bjoureaucracy — a process that will never result in the free flow of information required for transparency.
Markets work best when information is transparent for buyers and suppliers. But in most instances today, patients lack any comparative information and usually don’t find out the cost of their care until after the fact — if at all.
With this information, the millions of Americans who are self-employed, hold Health Savings Accounts, get their health care through employers or are uninsured will be able to easily find out what Medicare pays for a procedure, and be able to compare prices between doctors’ offices, hospitals and other health care providers.
For example, patients could see how often a physician performed certain lab tests, X-rays, MRIs or other treatments, and at what cost. Similarly, patients could also see the wide price variations between nearby hospitals, clinics and doctors’ offices.
With access to this type of data, consumer groups and other advocates could begin assessing quality of care while researchers could examine regional health disparities and identify ways to address them.
By opening the database up to the public, Medicare would serve as the anchor for the health care system. If costs go out of control, Medicare would provide the power needed to reel them back in.
This fundamental change might be uncomfortable for some people. While patients’ privacy would be fully protected by eliminating all identifying information, there have been some concerns about shedding light on individual practice patterns of doctors, hospitals and providers. Balancing the interests of individuals with the responsibilities to society as a whole is important and achieved by weighing these concerns against the overwhelming benefits of transparency.
The Medicare guarantee is a godsend and lifeline for millions of older and disabled Americans. Transparency provides a huge opportunity to help preserve that guarantee by holding down costs while at the same time improving health outcomes. This should be a transformational moment in the debate over health care — a moment when the most useful information about costs finally becomes easily accessible to patients, providers and insurers.
Sens. Chuck Grassley of Iowa and Ron Wyden of Oregon are co-authors of the Medicare Data Access for Transparency and Accountability Act.
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