Advancing public reporting through a new 'aggregator' to standardize data collection on providers' cost and quality

Health Affairs

Volumn 31, Issue 3, 2012, Pages 619-626

  Luft, Harold S ^a  

^a PALO ALTO MEDICAL FOUNDATION RESEARCH INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONSUMER; DATA COLLECTION METHOD; HEALTH CARE COST; HEALTH CARE QUALITY; HUMAN; INFORMATION PROCESSING; MEDICAID; MEDICAL CARE; MEDICAL RESEARCH; MEDICARE; PATIENT RIGHT; PUBLIC REPORTING; PUBLIC-PRIVATE PARTNERSHIP;

ACCESS TO INFORMATION; DATA COLLECTION; HEALTH PERSONNEL; HUMANS; INFORMATION DISSEMINATION; QUALITY INDICATORS, HEALTH CARE;

EID: 84858589925     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2011.1162     Document Type: Article

References (21)

1. The aggregator would probably allow several levels of "willingness to disclose." One level would probably be for general-purpose reports on quality measures to go into the public domain. A second level might be for reports on more detailed process, outcome, and resource use measures. These might both be more competitively sensitive and require more sophistication to use appropriately.
2. HHS.gov. Hospital Compare [home page on the Internet]. Washington (DC): Department of Health and Human Services; [last updated 2012 Jan 26; cited 2012 Feb 20]. Available from: http://www.hospitalcompare.hhs.gov/
3. CalHospitalCompare.org [home page on the Internet]. Oakland (CA): California HealthCare Foundation; [cited 2012 Feb 20]. Available from: http://www.calhospitalcompare.org/
4. Provider refers to the entity or person identified in a quality report. There was substantial, and unresolved, debate at the Summit on Public Reporting for Consumers regarding the focus of provider-specific reports. I use the term to refer to assessments of the performance of an individual physician or a small group of physicians who care for a specific patient, rather than assessments of the performance of all providers affiliated with an institution, such as a hospital or a large medical clinic.
5. Rothberg MB, Morsi E, Benjamin EM, Pekow PS, Lindenauer PK. Choosing the best hospital: the limitations of public quality reporting. Health Aff (Millwood). 2008;27(6): 1680-7.
6. Baker DW, Einstadter D, Thomas C, Husak S, Gordon NH, Cebul RD. The effect of publicly reporting hospital performance on market share and risk-adjusted mortality at highmortality hospitals. Med Care. 2003;41(6):729-40.
7. Voelker R. Study: few advocacy groups disclose grants from drug companies. JAMA. 2011;305(7):662.
8. Care is often provided by a team of clinicians, making it impossible to know to whom the patient's good or bad outcomes should be attributed. From the perspective of consumers trying to choose a provider-rather than the perspective of policy makers or providers trying to improve quality-performance measures should be attributed to the clinician to whom the patient is initially referred, if a specific problem is involved, or to the primary care physician normally responsible for coordinating a patient's care. Measures and reporting levels may vary according to the purpose for which the data are being used. For example, a patient may want to know the functional outcomes of other patients six months after a joint replacement by particular orthopedic surgeons and their teams. The surgeon may want to know performance indicators for anesthesiologists and physical therapists who may be asked to join his or her team.
9. Centers for Medicare and Medicaid Services. EHR Incentive Program: overview [Internet]. Baltimore (MD): CMS; [last modified 2011 Dec 5; cited 2012 Feb 20]. Available from: https://www.cms.gov/EHRIncentivePrograms/
10. Centers for Medicare and Medicaid Services. ICD-10: overview [Internet]. Baltimore (MD): CMS; [last modified 2012 Feb 2; cited 2012 Feb 20]. Available from: https://www.cms.gov/ICD10/
11. Whiting R. Automakers rev up datamining efforts. Information Week [serial on the Internet]. 2003 Mar 31 [cited 2012 Feb 20]. Available from: http://www.informationweek.com/news/software/productivity_apps/showArticle.jhtml?articleID=8700025
12. Smith SV. Marketers that you "like." Marketplace Tech [serial on the Internet]. 2010 Nov 26 [cited 2012 Feb 20]. Available from: http://marketplace.publicradio.org/display/web/2010/11/26/mmmarketers-like-that-you-like
13. Results of a lab test are clearly more sensitive than simply knowing that a test was done and paid for. If the results indicated a disease, however, subsequent claims are almost certain to indicate the condition being treated. Under the terms of the Health Insurance Portability and Accountability Act of 1996, payers are allowed to obtain such data and are obligated to keep it both confidential and secure. They are allowed to share deidentified data for research and quality improvement purposes without the specific authorization of each patient.
14. Pardee R. Questions and answers about the virtual data warehouse [Internet]. Seattle (WA): HMO Research Network; [cited 2012 Feb 10]. Available from: http://www.hmoresearchnetwork.org/resources/tools/HMORN_VDW-Questions-and-Answers.pdf
15. As a further safeguard, the patient and provider codes would be changed for each data set delivered, making reidentification by the data recipient even more difficult. No system is "uncrackable," but any organization attempting to relink data would place itself at risk of civil and criminal penalties.
16. Individual researchers might request access to the data, but they would almost always be affiliated with organizations that could ensure data security and had policies in place to prohibit attempts to reidentify the information
17. Currently, each research team needs to master the subtleties of using certain data and variables because there is no venue or reward for sharing such information. The aggregator would provide such a venue. For more details about how the information derived would be made available, see Luft HS. Total cure: the antidote to the health care crisis. Cambridge (MA): Harvard University Press; 2008.
18. Tumlinson A, Bottigheimer H, Mahoney P, Stone EM, Hendricks A. Choosing a health plan: what information will consumers use? Health Aff (Millwood). 1997;16(3):229-38.
19. Kaiser Family Foundation. 2008 update on consumers' views of patient safety and quality information: summary and chartpack [Internet]. Menlo Park (CA): KFF; 2008 Oct [cited 2012 Feb 20]. Available from: http://www.kff.org/kaiserpolls/upload/7819.pdf
20. Carman KL, Maurer M, Yegian JM, Dardess P, McGee J, Evers M, et al. Evidence that consumers are skeptical about evidence-based health care. Health Aff (Millwood). 2010; 29(7):1400-6.
21. Even without patient identifiers, someone with access to all of the aggregator's data could identify a few patients by matching patterns of use and demographics with known external information. Firewalls and other security are designed to address the risk from hackers, which is no different than the risk for data held by providers. But because the aggregator would never receive patient names and addresses, reidentification would be rare, and its data would be a low-value target for hackers