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Elusive claims data hold promise for healthcare research

As the US government reworks the country’s HHS. The court ruled that disclosure of the Real Time aren’t the only parties interested healthcare delivery system, information data would result in a “clearly unwarranted in Medicare claims data: during Checkbook’s relating to insurance claims is quickly invasion of personal privacy,” adding that appeal, the AARP and the Consumers Union becoming a hot commodity. the information was not useful to patients, of United States, among others, supported In January, the US Department of Health anyway. the company’s request for data. and Human Services (HHS) announced a Checkbook planned to use the data to The rationale behind the two rulings was plan to construct a nationwide database of create a free online site where patients different, but the message is clear—Medicare public and private insurance claims data could evaluate physicians on the basis of the claims data is off limits, even from the for use in healthcare research. The Federal number of procedures they had performed. Freedom of Information Act. Checkbook Coordinating Council for Comparative “It is a very large data resource that would has asked the US Supreme Court to review Effectiveness Research (CER) will use help the public, health plans, state healthcare their case. “One way or another, it is very stimulus funding to construct the database agencies and consumers evaluate physician important that this data get out there,” says for CER, a type of research popular with performance,” says Robert Krughoff, Krughoff. healthcare reform proponents that analyzes Checkbook’s president. Checkbook and Megan Scudellari, Durham, North Carolina the benefits, risks and/or costs of various medical procedures to determine the best treatment for a given condition. The HHS has already begun soliciting Troubles beset Thai health ministry vendors to design the database, but implementation is unlikely to begin until In a reshuffling of Thailand’s September, says Patrick Conway, executive government cabinet, the country’s director of the Federal Coordinating Council. education minister, Jurin Laksanawisit, It remains unknown who will have access to switched to take the position of public the database or how the HHS will obtain health minister and was confirmed in private claims data. “It depends on the design this new role on 18 January. The change and the access interface [of the database],” comes after allegations that the previous Conway told Nature Medicine. leadership of the health ministry The American Medical Association (AMA) mismanaged a health spending program is in favor of the database as a research tool, as worth 86 billion baht ($2.6 billion) long as research is not connected to physician established as part of the Thai economic payments or benefits, says Jeremy Lazarus, stimulus package. speaker for the AMA House of Delegates, The cabinet reshuffle was triggered by the organization’s policy-making body. the resignations of former Public Health “Physicians have a right to privacy,” he says. Minister Witthaya Kaewparadai and

© 2010 Nature America, Inc. All rights reserved. All rights Inc. America, Nature © 2010 The HHS database may someday offer Deputy Minister Manit Nopamornbodee researchers better access to claims data, after an investigation prompted by but private companies continue to struggle allegations of irregularities raised in to access the information themselves. In October by Thailandís Rural Doctors December, a US federal appeals court ruled Society. against a company seeking to obtain Medicare The Bangkok Post reported in October Newscom claims data—including doctors’ names, that the society’s president, Kriangsak addresses and performed procedures— Vacharanukulkiat, had met personally Lost in the shuffle: Outgoing health minister via the Freedom of Information Act. A with Thailand’s prime minister Abhisit Kaewparadai unanimous three-judge panel ruled that the Vejjajiva to discuss the allegations. Department of Health and Human Services Major concerns were raised about It also said the proposed purchase of is not obligated to release the data to Real plans to purchase medical equipment 38 chemistry analyzers and 16 blood Time Medical Data, a private company that that would have accounted for more count machines was unnecessary, would sell it to hospitals, physicians and than 25% of the procurement program. because these machines are available other medical entities. The ministry had reportedly planned to free of charge from manufacturers who In their decision, the judges cited a 1979 buy 80 ultraviolet sanitizers, 17 central gain revenue from sale of the chemicals injunctive order barring disclosure of monitors and 829 ambulances at prices required for their operation. Medicare reimbursement amounts. The that the society said were inflated. Kaewparadai reportedly denied that judgment is similar to a case argued last The Rural Doctors Society slammed he approved the purchases and said year in which a Washington, DC court of plans to purchase 13 anesthetic gas they had not proceeded; similarly, appeals prevented Consumers’ Checkbook, vaporizers for a total of 39 million baht Nopamornbodee said he was not part of the Center for the Study of Services, because they were not appropriate involved in any irregular purchases. a nonprofit consumer information company, investments for small district hospitals. Simon Grose, Canberra, Australia from obtaining Medicare data from the

nature medicine volume 16 | number 2 | february 2010 141