UNM Department of Anesthesiology and Critical Care Medicine

Mailing address:
MSC 10 6000
2211 Lomas Blvd NE
Albuquerque, NM 87106

Phone: (505) 272-2610
Fax: (505) 272-1300

Is it time for a HIPAA for physicians?

Three members of our department, Sarah Gebauer, Tim Petersen, and Elizabeth Steele, recently published an article in the journal Healthcare, accompanied by a post on the journal’s blog, arguing for more transparency and accountability in the use of physicians’ clinical data for quality ratings. The increasing availability of information sources like insurance claims data and electronic medical records have led, quite understandably, to efforts to use those data to evaluate physicians and hospitals for the quality of care they provide.

Drs. Gebauer, Petersen, and Steele argue that the explosion of ostensible rating services from the informal (e.g. Yelp) to the respectable (ProPublica and its Surgeon Scorecard) to the official (Hospital Compare, produced by the Centers for Medicare & Medicaid Services) has not always been accompanied by several factors that would improve the ratings’ reliability. Regulations surrounding these ratings exist, but standards vary greatly by state. Because of this, they argue for a national standard that covers physicians’ records of clinical performance and analyses based on those records. The proposed standard provides for notification of such analyses and a description of both the data used and the methods used in the analysis, minimum standards for the analyses themselves, and appropriate enforcement provisions.

With a transparent system, the authors hope that these analyses can be more useful for everyone. Physicians and hospitals want to improve. Patients want to be able to find good doctors and hospitals. Payers want to avoid paying for below-standard care. The data exist and the analyses are possible. Done right, everyone benefits.