How about not safeguarding physician privacy?

After 18 years of writing about the healthcare industry nearly every day, I continue to learn new things. Some of them fascinate me, but some others leave me shaking my head or wanting to bang it against a wall.

For instance, everyone knows patients have a right to privacy, but I just found out that doctors do as well. It's not to safeguard the medical records of their patients, but to make sure that anyone with an overly developed case of curiosity cannot broadcast to the public how much specific clinicians bill the Medicare program.

"For example, if a physician with a large Medicare patient base derives most of his or her income on a few procedures that happen to be on the list that is made public, anyone with a calculator and a Medicare fee schedule essentially could figure out how much that doctor makes in a year," argued the American Medical News in a 2009 opinion piece.

This has been established legal precedent for the last three decades, according to a recent article in the Wall Street Journal examining the millions in royalties medical device manufacturers pay to the orthopedic surgeons who have developed equipment to perform spinal fusion surgery.

Even though the surgeons may be barred from earning royalties on their own work, they'll earn money even if their closest colleagues perform such a procedure. Drs. Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno all earned more than $155,000 a month in royalties from Medtronic last year. All practice at Norton Hospital in Lousville, Ky.

Although Norton, with 610 beds, is on the large end for inpatient institutions, it's far from being one of the biggest hospitals in the country. Yet, it is the third-biggest in terms of volume of spinal fusion procedures performed on Medicare patients. That makes perfect sense: the more such procedures are performed at that hospital, the more the entire spinal fusion surgical team benefits.

Spinal fusion procedures cost Medicare $2.2 billion in 2008, more than six times what the program spent for such operations in 1997, even though there has been a long-running conflict as to the actual efficacy of such procedures. Medicare pays these surgeons upward of $12,000 for a single fusion procedure, which means even the trickiest of operations nets them a minimum of $2,000 an hour (meanwhile, most hospitals lose money on these surgeries). One surgeon the Journal studied received not only as much as $1.3 million a year in royalties, but performed a boggling 276 procedures in 2008 on Medicare patients alone.

Unfortunately, this spinal outlier couldn't be named by the Journal due to privacy concerns.

This is where I'm torn between head shaking and wall-banging. The huge geographical disparities in Medicare expenditures and our even larger anxieties about getting healthcare costs under control means the "privacy" of such doctors is expendable. Whenever they operate on a Medicare patient, they are not salaried employees, but government contractors. Virtually every organization that does work on the government's behalf has to abide by transparency rules. Ditto for these doctors--particularly if they're operating on patients who might be better served by physical therapy or other far less costly alternatives.

That the medical profession has been able to keep their specific Medicare earnings hush-hush is a testament to the skills of the American Medical Association attorneys who have been able to make their peculiar rationale stand up in court for decades. Or, perhaps the federal judiciary is blind to what seems to be obvious to many others.

Perhaps that's the healthcare lesson I've learned today: certain quarters of the country need to show some spine, rather than expose it for a procedure that seems to benefit its practitioners in outsize proportion to its recipients. - Ron