Two rulings in one week in a case involving an Idaho hospital’s purchase of a physician group gave health care journalists a couple of significant stories to cover. The first one set a legal precedent, and the second one gave us a rare up-close look into how hospitals can drive up costs when acquiring physician groups.
Interestingly, the judge cited the work of two health care journalists who have covered the issue of rising health care costs in the past year as being among the reasons to unseal documents the parties in the case wanted to keep from the public.
In the first ruling on Jan. 24, B. Lynn Winmill, chief judge of the U.S. District Court in Idaho, found that St. Luke’s Health System in Boise violated antitrust law (specifically, the Clayton Act and the Idaho Competition Act) when it acquired the Saltzer Medical Group, a 40-physician practice in nearby Nampa.
“This case represents the first time that a federal court has decided a case against a physician practice acquisition,” the health law practice of Epstein Becker & Green wrote on Friday in an alert to clients. The court ordered St. Luke’s to unwind the merger, although the hospital said it would appeal. Covering Health carried this story last week. Continue reading
In a victory for advocates of government transparency, a federal appeals court on Tuesday rejected the government’s arguments for withholding data on how much money individual retailers earn from food stamps.
Acting in a case brought by a South Dakota newspaper, the U.S. Court of Appeals for the 8th Circuit unanimously ruled against the U.S. Department of Agriculture’s claim that a federal law bars disclosure of retailers’ earning from food stamps.
The Argus Leader in Sioux Falls filed suit after the USDA rejected the newspaper’s Freedom of Information Act request for data on annual payments to individual retailers from 2005 to 2010. The USDA argued that a law protecting the privacy of retailers’ applications to participate in the Supplemental Nutrition Assistance Program or SNAP (the official name for food stamps) prohibited release of that information. A district court had earlier sided with the government, ruling that this information was exempt from FOIA, but the appeals court on Tuesday disagreed. Continue reading
As Charles Ornstein pointed out, the Centers for Medicare and Medicaid Services announced that it will release payment information for individual physicians in response to Freedom of Information Act requests, beginning in March. The move will increase transparency while still protecting the privacy of Medicare beneficiaries, according to a blog post by Jonathan Blum, principal deputy administrator.
According to a story in Modern Healthcare, the AMA has warned the Obama administration that it will be walking a thin line between balancing physician privacy rights with release of payment data – and that poor execution of the policy could lead to an unfair breach of confidentiality for providers and patients. Continue reading
(Editor’s note: This is a revision of the original post, which is available on Ornstein’s Tumblr site.)
The Centers for Medicare and Medicaid Services (CMS) said yesterday that it will soon begin releasing data on payments to individual physicians in the Medicare program.
Why is this such a big deal?
Because it overturns a longstanding agency policy that for more than three decades had barred the release of this very information. And, it follows advocacy for greater transparency by numerous news organizations, including the Association of Health Care Journalists.
AHCJ’s board of directors last September sent a letter of comment to CMS asserting the public’s interest in release of this information. “As long as patient confidentiality is protected, we see no reason why taxpayers should not know how individual physicians are spending public dollars,” said the letter, signed by AHCJ executive director Len Bruzzese.
In 1979, a federal court in Florida granted an injunction that prohibited the U.S. Department of Health, Education and Welfare (the predecessor to the Department of Health and Human Services) from releasing data on how much physicians earned under the Medicare program.
A year later, the HEW department adopted a policy that stated, “the public interest in the Department’s disclosure of the amounts that had been paid to individual physicians under the Medicare program was not sufficient to compel disclosure under the Freedom of Information Act.” Continue reading
News publishers in Idaho have asked the Ninth U.S. Circuit Court of Appeals in San Francisco to unseal pricing information that health insurers pay to hospitals and other providers in Idaho in an antitrust case stemming from a hospital system’s purchase of a physician group.
The publishers of the Idaho Statesman in Boise, the Idaho-Press Tribune in Nampa, and the Times-News in Twin Falls were joined by The Associated Press and the Idaho Press Club in the request to unseal the pricing data along with witness testimony and exhibits in the case, according to reports by Joe Carlson in Modern Healthcare and by Audrey Dutton in the Idaho Statesman.
The request was filed in November after U.S. District Court Judge B. Lynn Winmill failed to require lawyers to make compelling arguments for keeping the evidence sealed and keeping the courtroom closed at certain stages of the trial, Dutton reported.
Court documents (PDF) show that the pricing data was sealed before the trial began in September in Boise. Continue reading
Oklahoma Watch, a nonprofit investigative journalism team, recently published a two-part series on hospitals based on financial data obtained for every hospital in the state. As reporter Clifton Adcock writes in an article for AHCJ, the series revealed that between half and three-fourths of small general hospitals in Oklahoma were losing money, and that hospitals had spent only small fractions of their net patient revenues on charity care.
Hospitals get “disproportionate-share” (DSH) payments from the federal government to help cover costs for treating the indigent. Because Oklahoma was not expanding Medicaid under the Affordable Care Act, hospital groups said they expected to take a big financial hit from the law’s cuts to DSH payments. Oklahoma Watch wanted to see how much they relied on such payments. Continue reading
The 8th Circuit Court of Appeals held hearings yesterday on a 2011 lawsuit brought by the Argus Leader of Sioux Falls, S.D., over whether data about the payments made to businesses participating in the Supplemental Nutrition Assistance Program, formerly known as food stamps, should be publicly available.
As Josh Gerstein reports for Politico, an attorney for the newspaper argued that “a lower court judge misinterpreted the law by ruling that a confidentiality provision for retailer applications allowed the U.S. Department of Agriculture to withhold all data on payments to those retailers.” Continue reading
AHCJ has called on the federal government to release data about enrollment in the federal health insurance exchange as soon as the numbers are tabulated.
In a letter sent Thursday to Kathleen Sebelius, secretary of health and human services, and Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, AHCJ president Karl Stark asks for daily or weekly updates, rather than the monthly updates the administration has planned.
“This information is critically important, not only for journalists but for professionals involved in ACA-related work and any American who wants to buy health insurance,” Stark wrote. Continue reading
Alice Dreger, a professor of clinical medical humanities and bioethics at Northwestern University’s Feinberg School of Medicine, writes for Pacific Standard Magazine about the public health threat caused by public officials who censor news, fail to respond to press queries or prevent health agency employees from speaking to journalists without a representative from the press office.
Dreger points to the current Middle East respiratory syndrome (MERS) crisis, referring to a piece in Wired by AHCJ board member Maryn McKenna. But she also reminds us that it was journalists who sounded the alarms about the dangers of thalidomide and the Tuskegee Syphilis Study, not to mention the journalists who pushed for more public awareness of AIDS when the Reagan administration was limiting the response to the emerging disease. Continue reading
AHCJ’s board of directors called on the federal government to release data on physician payments and utilization of services in the Medicare program.
In a letter sent Tuesday (PDF) to the Centers for Medicare and Medicaid Services, the board said the release of the information is “long overdue.”
“The value of such information to the public far outweighs any privacy claims of physicians,” said the letter, signed by AHCJ executive director Len Bruzzese. “As long as patient confidentiality is protected, we see no reason why taxpayers should not know how individual physicians are spending public dollars.”
The letter came in response to CMS’ call for comments last month about whether and how it should release data on physician spending in Medicare Part B, the outpatient component of the program. A U.S. District Court in Florida overturned a 1979 injunction that had blocked the public release of data identifying payments to individual doctors. Dow Jones, which publishes The Wall Street Journal, challenged the injunction.
“The U.S. District Court was correct in lifting the 1979 injunction in response to dramatic changes in the health care landscape over the past three decades,” AHCJ’s letter said. “Beyond that, we believe an informed public makes better health care decisions.”
AHCJ cited stories by The Wall Street Journal and the Center for Public Integrity as examples of how reporters can use physician claims data for stories in the public interest. But it said those stories would have had wider resonance if the organizations were able to name physicians and allow members of the public to look up their own doctors. Continue reading