Docs fighting innovative program designed to compare costs, outcomes
Passage of a law to collect patient-level data from physicians in Wisconsin was only the first blow. Now comes the real battle as regulators design rules for what appears to be the first comprehensive collection of publicly available patient-level data on physician office visits. The lawmakers want to publish financial and clinical data on physician services for consumers, purchasers, and other health care providers, much as it currently does for hospitals.
The 1998 law that expanded the state’s authority to collect the information is intentionally broad. Details will be hashed out in the promulgation of rules in early 1999. Yet, there’s enough history and debate to suggest that the state will at least require data on type of procedure, charge, ZIP code, and treating physician.
The State Medical Society of Wisconsin, which fought bitterly to prevent enactment of SB 315, targets "data collection" as one of its 12 priority issues for the legislature’s 1999-2000 session. The organization will not try to have the law repealed, but will reintroduce a proposal to require a patient’s informed consent before outpatient data are provided to the state, says Colleen Wilson, medical society legislative counsel.
The medical society is not at all comforted by the fact that the state’s nine years of collecting and disseminating patient-level hospital data has not resulted in a breach of confidentiality. Draft rules would require collection of far more data at a finer level of detail than has ever been collected from hospitals, Ms. Wilson says.
A co-sponsor of the bill who defended the legislation through a bruising re-election campaign is ready to fight for it again.
"We should let the law happen," says Gregg Underheim, a Republican representative from Oshkosh. "We will not be dissuaded from implementing the law because of scare tactics which do not address legitimate privacy concerns," he says. Existing provisions that protect the confidentiality of hospital data are extended to physician data in the new law.
Mr. Underheim claims a large and varied constituency for the bill: the American Association of Retired Persons, Wisconsin Manufacturers & Commerce, the state teachers’ union, the AFL-CIO, the National Federation of Independent Businesses, the Coalition of Wisconsin Aging Groups, the Wisconsin Health and Hospital Association, and the Association of Wisconsin HMOs.
Legislators directed the state’s Office of Health and Family Services to use the state’s emergency rule-making track to implement the law. "We wanted to get it up and running as soon as possible," explains Sandy Lonergan, research assistant for Mr. Underheim. Still, legislators don’t expect the process to yield usable data for two to three years.
State officials already can collect patient-level data from hospitals and ambulatory surgery centers. SB 315 brings "healthcare providers," including physicians, under the data-collection umbrella. The information to be collected already is captured on Health Care Financing Administration form 1500 used for Medicare and Medicare billing or the UB-92 used by private payers.
The medical society, which represents about 8,000 of the state’s 10,600 licensed physicians, pooh-poohs the notion that physician claims data offer the key to sound decision making. "Simply put, claims data will not tell patients about the abilities of their physicians or the effectiveness of the treatment ordered by a physician for a specific condition," warns a position paper published by the society.
Moreover, the hospital data are notoriously inaccurate and do not set a reliable standard for collection of physician data, Ms. Wilson says.
Wisconsin’s attention to physician data reflects an ever-increasing migration of health care services to outpatient settings. Between 1970 and 1996, the proportion of the nation’s health care expenditures that went to physician services grew from 18.5% to 19.5%, and is expected to grow to 20.0% by 2007.
While the percentage increase may be modest, it comes simultaneous with a huge explosion of health care expenditures. During the same time period, health care spending multiplied almost 30-fold, from $73.2 billion in 1970 to an estimated $2.1 trillion in 2007. In the September/October 1998 issue of Health Affairs, actuaries project that growth in physician expenditures during the next 10 years will come from both public-sector and private-sector spending.
The Wisconsin legislature has appropriated $250,000 in general revenue to test data-collecting mechanisms. Like the hospitals and ambulatory surgery centers that already give the state data, physicians will be assessed the cost of collection and reporting the information. The law caps the annual physician assessment at $75.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content