Warning that new legislation poses a threat to patient privacy, Wisconsin physicians are mounting a last-ditch campaign to kill legislation that would enable the state to collect financial and claims data directly from physicians' offices.
WI physicians fight state data collection.
April 30, 1998
Wisconsin physicians fight state data collection
Medical society says release of MD claims data threatens patient privacy
Warning that new legislation poses a threat to patient privacy, Wisconsin physicians are mounting a last-ditch campaign to kill legislation that would enable the state to collect financial and claims data directly from physicians' offices.
The State Medical Society of Wisconsin is urging the governor to veto Senate Bill 315, not only because of the privacy issue but because of the administrative burden it would place on physicians.
In what some supporters of SB 315 denounce as a scare tactic, the medical society is appealing directly to consumers with a patient brochure featuring a bold-print, cover-page warning that "This visit with your doctor will be reported to state bureaucrats without your permission." The brochure tells consumers to "report your condition to your doctor, not Big Brother."
Many consumers "don't understand" that what goes on during an office visit is "not necessarily between them and their physicians," said Kathy Andersen, associate director of government relations for the medical society. Ms. Andersen said the state's data collection is a "huge invasion of privacy for no purpose."
Wisconsin physicians have another reason to be concerned about the state's data collection. Wisconsin employers and purchasers plan to use the data to negotiate direct-contracting arrangements with physician groups. Physicians also are worried the information could be used to
drive down charges for physician services.
Employer coalitions have already been successful in using data on statewide hospital charges to drive down their hospital costs.
Chris Queram, chief executive officer of The Alliance, a coalition of 800 large and small employers in the state representing 80,000 covered lives, said one of the immediate benefits of the data collection effort is that, for the first time, there will be statewide information on physician charges and on utilization of services.
Data on physicians will bring even more information into "the public realm" and will allow for even "more sophisticated purchasing," he said.
The information will mostly be used by purchasers for "challenging costs and questioning charges based on comparisons," said Ms. Andersen. "It would be a violation of antitrust if anyone was collecting this data but the state."
Purchasers maintain the data will be used to improve quality, not just drive down costs.
SB 315 clears the way for the Office of Health Care Information to collect data from physicians just as it has collected discharge data from hospitals for the past eight or nine years and just as it collects data from ambulatory surgery centers. Data from physicians also would be used in the future to develop report cards for consumers. The report cards won't be available for two years, however.
The state must first conduct a two-year pilot, said Barbara Rudolph, director of the Office of Health Care Information. In the first year, the office will determine what data will be collected, from what type of physician, and in what areas of the state. Ms. Rudolph said the state office also must decide on the most appropriate severity-adjustment tools for the data and on the information that will be most valuable to consumers in choosing health care providers. The data will be collected in the second year from the HCFA 1500 forms already used by physicians.
The medical society has been joined in its battle against SB 315 by the American Civil Liberties Union, which argues that the data collection is a threat to patient privacy because the state does not obtain patient consent for the use of the information. The ACLU also says that even though patient identifiers are used to protect patient privacy, as more and more data is linked from different sources, the chances for a breach of privacy increase.
Ms. Rudolph said her office is prohibited from collecting names, addresses, social security numbers, or other unique patient identifiers. The state will not link inpatient and outpatient data to protect patient privacy. Unfortunately, this also means the state cannot follow health care treatment from event to event. If a consumer asked to see his or her medical record, "we could not find it," she said. "Consent isn't really yours to give if no one can identify you."
Ms. Rudolph said the one privacy issue she sees involves the records of consumers who have rare conditions or live in sparsely populated areas.The state uses a variety of software programs to mask these records.
Eric Borgerding, director of legislative relations for Wisconsin Manufacturers and Commerce, a major supporter of the legislation said the medical society's concerns about breaches of privacy seem focused on computer hackers. He was also critical about the society's publicity campaign.
"It's amazing that a state medical society would print up brochures and ask members to scare patients by giving them out," said Mr. Borgerding. He characterizes the brochure as "misleading at best."
"Patients have the right to know what state government intends to do," responds Ms. Andersen, who notes that the society is sending one copy of the brochure to each member, who may or may not choose to reproduce it and distribute it to patients.
Ms. Rudolph said the state has been losing a significant amount of data as more procedures are done on an outpatient basis. Of the top 100 procedures, the state annually loses data on 44,000 cases now being done in physicians' offices.
Approximately 60% of all health care dollars are spent in non-hospital settings. Employers, business coalitions, unions and other users of data will be able to use the physician data to monitor quality of care, practice patterns and utilization of services. Purchasers also will be able to monitor for underutilization of services under
managed care.
Ms. Andersen argues that if the state wants to collect this data, it should collect it from health plans. The four or five other states that collect physician data do largely collect it from health plans, said Ms. Rudolph. However, Wisconsin decided to collect it from physicians instead of plans because 60% of the population is covered under ERISA plans. The ERISA pre-emption of state regulation could create an obstacle to the data collection effort.
The legislature rejected state funding for the expansion of state health care data collection to include claims data from physician offices. A tax on physician license fees will fund the state effort.
Contact Ms. Rudolph at 608-267-0236, Mr. Borgerding at 608-258-3400, and Mr. Queram at 608-276-6620.
Warning that new legislation poses a threat to patient privacy, Wisconsin physicians are mounting a last-ditch campaign to kill legislation that would enable the state to collect financial and claims data directly from physicians' offices.
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