State Suspends Proposed Release of Physician Data
April Talks Slated to Discuss Plan Further

by Tom Walsh

Concerned that a proposed change in a state regulation might lead to inappropriate release of “raw” physician performance data that could disrupt patient care and unfairly discredit some doctors, an MMS-led coalition convinced the state Division of Health Care Finance and Policy (DHCFP) to hold off on the regulation change until it can be further reviewed.

The proposed amendment would have authorized the release of physician license numbers as they pertained to hospital data. In its formal comments to the state agency, the Society said the amendment might have had additional unintended consequences resulting from patients being prompted to switch physicians: increased costs, duplicated testing, delays in necessary treatment, and added stress to the health care system.

The proposed regulation change made no provision for doctors to see their personal data before its release. “If data is to be released, it should go to the physician in advance so the doctor has a chance to review it and have any errors corrected,” said Kenneth Peelle, M.D., MMS president-elect. “We have no trouble with data being posted if physicians get to correct it for accuracy in advance.”

After receiving cautionary comments about the proposal from the MMS and others, including doctors from the Partners and Beth Israel Deaconess physician organizations, Amy M. Lischko, DHCFP commissioner, said on Feb. 28 that the division would not adopt the changes in light of “the issues raised in the written comments.” She added that “consultative sessions” would take place “for further discussion of this important initiative.”

MMS President Alan M. Harvey, M.D, M.B.A., praised Lischko’s decision to hold back the changes, at least until further discussions can be held with the MMS and others. “We look forward to continuing a strong working relationship with the division to help improve clinical outcomes for our patients and educate the public on legitimate measures of quality care,” Dr. Harvey said.

DHCFP spokesperson Dick Powers told Vital Signs on Feb. 28 that talks about the proposed regulation change would occur in four to six weeks -- approximately early April.

Story Begins Quietly
The story of “114.5CMR 2.00: Disclosure of Hospital Case Mix and Charge Data,” as the regulation is formally known, began quietly enough on Jan. 6, with the division’s formal indication that it sought to make changes.

“The proposed amendments add a new data element, the Board of Registration in Medicine physician license number, to the data that may be disclosed through the division’s confidential data request process,” the DHCFP explained in its formal filing. According to the original regulation, the number that identifies individual doctors in Massachusetts in data such as this is “encrypted” -- able to be reviewed by the state agency, but not by researchers or others in the public, who have access only to aggregated information.

In its original filing, the DHCFP maintained that encrypted data “does not provide sufficient detail to improve health care quality research…. Given the need for greater transparency in health care data, the division proposes to make available to researchers the unencrypted physician license number in accordance with the security and confidentiality requirements of the regulation.”

MMS staff flagged this amendment soon after it was formally proposed. Society officials contacted their counterparts at several physician organizations. None of them had heard anything about the proposed changes.

“If the Mass. Medical Society hadn’t called me, we would not have known anything about it,” said Rich Parker, M.D., medical director of the 1,400-physician Beth Israel Deaconess physician organization.

No Public Hearing
The proposed amendment was filed with a Feb. 24 deadline for public comment. As of that date, the division could have put the revised regulation into practice. The filing made no provision for a public hearing on the proposed changes.

However, the MMS and other physician groups recognized the proposal as a “sea change” in the way the state handles sensitive health care data that involves physicians, said Elaine Kirshenbaum, MMS vice president of policy, planning, and member services. “There needs to be a public hearing vetting process to make sure we all understand this,” she explained.

Kirshenbaum added that there have been numerous errors in physician data in the past, emphasizing that “public reporting involves the lives of both patients and doctors and therefore must proceed thoughtfully and collaboratively.”

MMS Weighed In
On Feb. 17, a week before the close of the public comment period, the Society sent a letter to the Division of Health Care Finance and Policy asking that the proposed regulation changes be discussed at a public hearing. “The MMS believes that a change of this magnitude warrants a public hearing rather than the brief comment period proposed,” the letter stated.

When no public hearing was scheduled, the MMS submitted a more lengthy commentary to the division on Feb. 24. Citing a Massachusetts law requiring that individual physicians be allowed to review any profiles prior to them being made public, the MMS urged the DHCFP to “rescind the current proposed regulations and issue a new draft designed to support the release of accurate and useful information.”

The MMS commentary noted that the Society worked recently with the division on the release of data on 10 surgical procedures. However, the commentary continued, “The release of clinical data on hundreds of procedures by thousands of physicians is entirely different. It may well result in the generation of inaccurate profiles that cause patients to distrust their current physicians or seek new physicians with unwarranted excellent ratings.”

The State Listened
At the Division of Health Care Finance and Policy, state officials took note of the strong opinions voiced by the MMS and other physician organizations. On the last day of February, the division decided not to adopt the revised regulations and instead pledged to open a new dialogue on the matter.

“We will continue to work with interested parties to ensure timely access to health care data that will inform decision making and promote the efficient delivery of quality health care,” said a statement from the DHCFP.

In expressing the Society’s appreciation of the division’s call for further review, Dr. Harvey responded, “We support transparency. But the MMS believes it is something that has to be done right -- for the benefit of patients, physicians, and the entire health care system.”