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Whose Data Is It, Anyway?

Cheryl Clark, for HealthLeaders Media, April 18, 2013

The Harvard project evaluated coded charges at a 12-hospital healthcare system in Texas, and discovered that when privately insured patients developed complications, the system made three times as much money, as it did when insured patients' procedures went without a hitch.

The paper is being seen as a call for health plans to renegotiate how they pay for care when something goes wrong. It also is being seen—incorrectly I believe—as evidence that hospitals and doctors are purposefully causing complications to increase profits.

Wachter emphatically insists that, despite the implications of the Harvard report, "I do not believe there is any hospital or doctor in the country who is trying to harm people to make more money. Nobody sits there at a board meeting or in the C-suite and says 'We're okay with these complications because we're being paid for them.'

"But what they do say is, 'Boy, we need to build a new OR, or we need to do more marketing or hire another cardiac surgeon and that will cost a lot of money. Do we do a teamwork training program or buy a bar coding system? Well no. This year we can't afford it.'

"If the business case were stronger, then (quality improvement) would rise higher in the priority list," Wachter says.

Some hospital officials and doctors will argue that quality measurement as they're reporting to these registries is fine for that purpose, but not fine for a platform on which to base how they're paid and publicly reported.

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2 comments on "Whose Data Is It, Anyway?"


Jason Uppal (4/21/2013 at 9:33 PM)
I am an engineer by training and worked many years in several industries in business transformation. Quality improvement is a fundamental component of business transformation. The mistake the healthcare industry is making the same mistake Detroit automotive industry made 35 years ago. Quality improvement measures such as internal process audits, compliance audits, adverse events are used to ensure the process effectiveness, not to taut your quality score. If you want to measure quality of healthcare at a hospital let them publish patient satisfaction, patient outcome for an episode, length of stay, total cost to achieve that outcome. Those measure matter to the public. When I buy a car, I don't care how many times the assembly line was stopped by a worker because a non compliant product, I care how often I need to take it back to the dealer for fixes that should have never occurred and what I paid for it.

Jane Alop (4/19/2013 at 12:03 AM)
I agree, publicly paid serviced should be transparent to public, but we have to remember it might be also confusing information to public. What is the purpose - to pay less (optimum) or to have a better health care quality? Usually the answer is P4P what means in some cases we pay more for good quality and in some cases we will not pay for poor performance. In both cases we need criteria to identify the quality of provided care and this can be done only by clinicians and patients and its pros and contras are proved in thousands surveys not mentioning the quality of the data from specialty registers this data come from. In Estonia we are very cautious thinking P4P implementation thanks to Alan Maynard report. Estonian Health Insurance Fund, who is a main purchaser, aim is to have better and on equal level quality in whole country. For that purpose we [INVALID] yearly a feedback report to hospitals using the data from invoices the hospitals send to insurance fund to get paid. Based on this data we calculate common quality indicators. Yes, this is a very robust analyze and we all have to remember the data is not specially collected for quality assessment, this data are from a financial document. But this is also the value of it - insurance fund database is most complete database as everyone want to be paid :). Second - the provided services are coded based on insurance fund pricelist all provider have to use. If someone is not happy with results and put the question about data quality it always goes back to hospital as insurance fund don´t change the account information sent by the hospital. The main purpose of this report is to provide feedback to hospitals that they can compare themselves to other hospitals in Estonia and to provoke IN hospital discussion about possibilities of quality inprovement. It is also the way to do benchmarking. And we don´t spend any extra money for collecting this data :) - we are a very small country and can use very limited amount of resources.