Transparency talk in D.C. heats up

There has been much debate lately on just how to make healthcare information transparent. I have blogged for years and recently published a detailed article in JAMA  co-authored by Don Berwick on the subject. In the article, we describe both how Medicare data should be released and what it should be used for.

Elected officials have now picked up on the importance of releasing the Medicare data to the public. I am absolutely supportive of the Medicare data release in any form but I do believe that our approach, as outlined in the JAMA article, is better than simply releasing all the data to everyone. We have had seven years of experience of releasing commercial and Medicaid data.  We have found it is harder than one might think to accurately reflect the true performance of any single doctor. There are issues with attribution of patients to doctors, small numbers skewing results, and other problems. It's not to say we haven't worked through these problems to deliver a data set to physicians in Wisconsin that is accurate and reliable. But it does take expertise to assure the quality of the data.

In this recent article in Politco, the author argues for release of data with no constraints. There are billions of bits of data in the Medicare data file. We spend over a million dollars a year simply managing the integrity of the data in Wisconsin at the Wisconsin Health Information Organization (WHIO). I believe that releasing the entire Medicare data file to anyone will create chaos. Without data standards, attribution logic, and data cleansing procedures, we will end up with inaccurate information that doesn't help anyone make good decisions. A better way to manage this process is through determining which organizations qualify to accept and manage the data base responsibily. WHIO is one such organization as is the Center for Improving Healthcare Value (CIVIC) in Colorado. WHIO and CIVIC, as well as similar organizations, are best positioned to accept and manage the Medicare data set.

CMS has established the Qualified Entity (QE) program which is meant to establish the criteria for the organizations that can accept Medicare data. As a QE, the organization must be able to manage HIPPA requirements, establish a reconciliation process for providers who believe the data to be in error, and meet important data management standards. I believe these rules are important to comply with to assure the successful release of the Medicare data to the public.

Read the Politco article here.

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