Thursday, October 28, 2010

Open the Medicare Claims Data Base to the Wisdom of Crowds.

If you believe that CMS has what it takes to make sure that Medicare claims are paid the right way for the right patients most of the time, you may need to think again. According to this article in the Wall Street Journal, it's too easy for the government to misspend millions of dollars for dubious care involving questionable doctors.

But Medicare's fiduciary ineptness is not why this article is worth reading.

If you believe the Journal, the Medicare claims data base, otherwise known as the "Carrier Standard Analytic File" is a gold mine of information that, but for archaic privacy laws, could be used to spot those questionable doctors. Organized physician groups have generally opposed the public release of those doctors' names, even if it involves public money.

But physicians' right to privacy vs. the public interest is not why this article is worth reading.

Rather, this article is important because it portrays the power of allowing open access to the government's health insurance claims databases. The Journal simply sorted Medicare claims costs by provider and came up with some potentially important insights. Imagine, says the DMCB, what would happen if everyone could access the data from the world's largest insurer and mine it for correlations, regressions and other statistical whattnot. There are a host of amateur statisticians who could not only uncover important practice patterns, but mine other unknown associations involving demographic information, the incidence of disease and likelihood of successful cure. It's called the wisdom of crowds.

While privacy for patients and physicians is important, reasonable protections are possible. As for Medicare itself, the program would not only benefit from the clinical insights that would be uncovered, but other investigations similar to the Journal's might make it more responsive to acting on potential fraud.

Last but not least, those data belong to the American public.

The data are too useful to lock away from its owners. This is an idea whose time has come.

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