Potential Data Breach and Extortion at Express Scripts

The WSJ Health Blogs reports about a potential data breach at Express Scripts, one of the largest pharmacy benefit management companies in North America. More from Express Scripts on the Facts, FAQs and Other Resources.

The potential data breach came to Express Scripts attention after having received an anonymous letter attempting to extort money from the company by threatening the expose millions of patient records. The threat letter included personal information on 75 members, including names, dates of birth, social security numbers and prescription information.

The article also mentions a similar extortion related data breach which occurred in March 2006 and involved Medical Excess LLC, a subsidiary of AIG. In that case the FBI investigated and arrested an individual who stole a computer server containing personal health information of more than 900,000 individuals. The individual tried to extort AIG for $208,000 after threatening to release the information on the Internet.

According to the FBI Press Release, the individual involved was the first person to be charged under the new federal criminal statute, Title 18 U.S.C. 1030(a)(7)(B) and (C). The new federal criminal statute makes it a federal crime to commit extortion relating to unauthorized access of, or damage to, a protected computer system and/or to impair the confidentiality of information obtained from a protected computer.

To learn more read Express Scripts' press release and related support site.

Consumers' Checkbook v. HHS Update

The WSJ Health Blog, "Feds Fight to Keep Doctor Data Secret," has the latest on the Consumers' Checkbook v. HHS matter involving whether or not Medicare physicians claims data should be made publicly available. Consumers' Checkbook, a nonprofit consumer information and service resource, wants to use the data to rate physicians and health care services.

Last week the DOJ filed its appeal and HHS released this statement regarding appeal of Consumers' Checkbook Decision explaining the basis for opposing (and supporting) release of the data. The press release states:

HHS is appealing this decision because of two conflicting court opinions that control HHS’ release of data. Release of certain Medicare claims data is currently governed, in part, under an existing order issued by a federal court in Florida in 1979. That order, which is still in effect, prohibits Medicare from releasing physician reimbursement data in a manner that would enable the user of that data to identify individual physicians. The court order states that this information is protected by the Privacy Act of 1974. The data sought by Consumers Checkbook, when combined with other publicly-available data on Medicare fees, could lead to the disclosure of annual Medicare reimbursement amounts for individual physicians. Release of the data would, therefore, result in a violation of the existing Florida court order. On the other hand, HHS faces the decision rendered last year by the District of Columbia court ordering the release of the data. HHS argues in its appeal that the recent decision is based on an erroneous application of the Florida court order and of the Freedom of Information Act’s exemption that protects privacy. The Department seeks resolution of this conflict from the Court of Appeals.

Beyond the legal issues that must be resolved, HHS recognizes and shares the goals of Consumers Checkbook. Like Consumers Checkbook, HHS seeks to support consumers and providers with quality performance and cost information for a variety of providers and plans. For many years, HHS has worked closely with providers and other stakeholders in developing and reporting quality information, including the use of national consensus-based quality performance measures. While Consumers Checkbook seeks to post the number of times a provider has performed a specific service, the quality measures used by HHS generate more valid, specific, and comprehensive information on the quality of care delivered.

For background on the legal saga check out my prior post.

Practical Advice on the Death Spiral

The Death Spiral, courtesy of the WSJ Health Blog.

Great graphic which highlights advice from my dad, a retired physician in West Virginia, who always warns us of such risks. He says, "eat better, eat less, take small bites, drive defensively with two hands on the wheel, don't climb ladders and be careful with guns." Looking at the graph if we listened to this advice we would take care of most of the larger circles.

Dartmouth Atlas Health Care Stats on End of Life Care Costs

The WSJ Health Blog posts (WSJ article, More Choices Drive Cost of Health Care) interesting statistics on end of life care costs according to the latest Dartmouth Atlas of Health Care edition (due out today).

The report shows:

. . . that the cost of individual medical services isn’t the big driver of Medicare spending, at least for chronically ill patients in their last two years. It’s the intensity of care, such as the number of specialist visits and days in the ICU. . .

According to the map graphic West Virginia comes in low in the "below $37,500" category showing the average Medicare Spending during the last two years of life for chronically ill patients.

As the costs of our health care system increase over the coming years we will likely see an increased focus on looking at the end of life care issue vs. costs of health care in those remaining years. These bring to the front a variety of medical, ethical and legal questions.

Physicians vs. Patient: Rating-Permission Contracts

Interesting post from the WSJ Health Blog on Medical Justice's new ratings-permission contracts (press release on service).This new service offered by Medical Justice appears designed to attempt to control the evolving growth of health care consumer driven rating information provided through companies like RateMDs.com.

According to Medical Justice's CEO the goal is to "regain control of the flow of information." Just more evidence of the dynamic shift we are seeing in the health care industry as a result of some of the health 2.0 initiatives.

New models are being developed to allow patient/consumers to rate, report and compare the quality and cost of health care services. As these services become more widely adopted and used by consumers, traditional health care delivery system models and the perceptions of health care professionals are being challenged.

Note: Don't miss reading the reader comments in the WSJ Blog post.

UPDATE: More from Dr. Val on the potential value of online physician rating. I completely agree with her comment that sometimes all that is available is a "health insurance company's list of in network professionals."