Federal officials were skeptical two years ago when ProPublica asked them
to release a database of prescriptions written in Medicare’s landmark drug
plan, known as Part D.
The data details the prescribing habits of more than 1 million doctors and
other health professionals who treat Medicare patients. The Centers for
Medicare and Medicaid Services had never allowed any outsider, let alone
journalists, to have access to such records, which include identity codes for individual
providers.
In the months that followed, ProPublica reporters argued that freeing
this data could help patients assess the prescribing patterns of their health
providers. The reporters pointed out that the stringent laws on the
confidentiality of medical records were written to protect the privacy of
patients, not doctors.
After months of high-level deliberation, CMS, to its credit, agreed to
release the records — and to unveil one of medicine’s biggest secrets.
In examining
the data, our reporters found powerful indications that Medicare has not done
all it could to oversee its drug plan.
Some of our nation’s most vulnerable citizens rely on this program —
the elderly and disabled. We found that some doctors were prescribing
antipsychotic drugs to large numbers of seniors — an age group for which such
medicines are particularly hazardous. Others were writing unusually high numbers
of prescriptions for painkillers and other dangerous drugs. Reporters systematically
examined these cases, interviewing the doctors about their prescribing
decisions. In some cases, they could explain their conduct. In others, they
could not.
They all had one thing in common: None of the doctors whose
prescribing habits stood out in our analysis had ever been questioned by
Medicare officials. Government overseers, our reporters found, didn’t consider
it their job to examine these patterns or act upon them.
The story we’ve published today with The Washington Post is the first
in a series that will delve into critical gaps in government oversight of
public programs that annually spend billions of dollars in taxpayer money for prescription
drugs.
Officials at CMS, the agency that runs Medicare, contend the program
is running smoothly. They have rebuffed calls by the Inspector
General at the Department of Health and Human Services to tighten oversight of
the drug program. Their own records offer a powerful rebuttal.
Beyond surfacing dangerous prescribing habits, the information we are
making public with this story has the potential to change the doctor-patient
relationship.
Until now, only insurance companies, government officials and
pharmaceutical manufacturers have been able to track prescriptions written by
individual doctors. Pharmaceutical companies have used such data to see how
often doctors choose high-priced, name-brand drugs over generics, or pick one
manufacturer’s product over a competitor’s.
The companies have bought this information from middlemen who collect
it from pharmacies. Several years ago, ProPublica attempted to purchase this
information from one of these companies. We were told it would not be available
to us at any price.
The story and online news application, called Prescriber Checkup, put
a significant chunk of that information in the hands of the public. You will be
able to review the prescription patterns of nearly 350,000 Medicare providers, including
the most prolific, and see how they compare to others in the same specialty.
Like all data, this information is just the starting point for a larger
conversation. There are many reasons one health provider’s prescribing patterns
could vary from those of his or her peers. Doctors with sound approaches can
stand apart if they have unusual patient populations, for example.
But the release of this information will give health professionals and
patients new insights. A number of doctors we interviewed said they welcomed
the chance to see where they stood.
Because
this data is so potentially valuable to patients and doctors, we are making
nearly all of it available immediately to researchers and the public on our
website.
We expect that journalists, scholars and patients will find this
information of use as the nation continues to debate the future of American
health care.
