Physician Payment Data is Where the Action Is

Look beyond the EHR incentive program. A national effort to turn CMS's recent release of Medicare physician payment data into useful, actionable data visualizations is the hottest HIT challenge right now.

The days of building electronic medical record software are over.

Oh sure, EHRs will continue to get built, improved, "skinned," perhaps even reimagined.

But with the EHR incentive program beyond its peak, attention is shifting to other important aspects of the healthcare technology spectrum.

Last week in this space, I described how entire communities are engaging in friendly competition to leverage the many digital breadcrumbs that make up today's total population health picture.

The Way to Wellville effort is a five-year marathon. Health Datapalooza's Code-a-Palooza is an opportunity for a variety of stakeholders, healthcare systems included, to step forward and compete in a national one-month sprint to turn CMS's recent burst of Medicare physician payment data into useful, actionable information for patients and payers alike.

While this data gives patients the opportunity to compare and contrast physician-level data on charges, it is a lot of information to sift through.

That is the challenge for Code-a-Palooza entrants. A collaboration among Health Data Consortium, the ONC and CMS, developers are invited to use the newly released data to create a data visualization that improves consumer decision-making when it comes to selecting a physician or procedure, in turn helping to potentially reduce costs and increase value to the patient.

Health Data Consortium will award $35,000 to three top teams at Health Datapalooza on June 3.

To learn more, I spoke with Health Data Consortium CEO Dwayne Spradlin. Last year, Spradlin reminded me, an earlier competition used a specially prepared CMS data set that had not been made public. This year, for the first time, the competition is based on public data. That should drive lots of discussion, and no small amount of controversy.

Last year, the competition winner was a team of doctors who had coding chops. You never know where in healthcare such tech talent may be waiting.

"I would be floored, in fact, if we don't have quite the diversity of individuals and teams registered," Spradlin said.

I responded that there is this conventional wisdom that healthcare is so far behind the technology curve that mere doctors cannot be expected to be the leading technology innovators, but instead must be rescued by the rocket scientists, Wall Street quants and other Brainiacs who populate so many venture-backed healthcare startups, parachuting in as if their ignorance of the healthcare system is some sort of advantage.

There may be some truth in such thinking. "There's an adage in the field of open innovation, which is some problems are too big to leave to the experts," Spradlin said. "Very often, if the expert in a particular field could solve a problem, they would have already." So, will there be contenders from outside of healthcare? You bet.

And yet, Code-a-Palooza may continue to put the lie to this stereotype.

"You do need the people who are the subject masters to really come in and say take this data set from CMS and make it do things that really matter to healthcare," Spradlin said.

But as Spradlin reminded me, last year's winners "did not represent your father's healthcare system. They were fearless, unafraid. They had been brought up in the develop arena as well. They saw a need to do some things differently."

But just to set expectations, remember that the recently released CMS data is all about cost, not quality. The full matching set of quality data is locked up still somewhere in CMS, and since I understand the agency operates at least four separate data warehouses, it could be some time before we see a truly complete coding competition.

That will invite in the controversy, because just looking at cost without the associated quality measures is bound to be taken out of context by someone somewhere. To some extent, because the newly released data hasn't been poured into apps as easy to use as Yelp, some of that controversy hasn't erupted yet. And there's always the possibility that a Yelp-style app won't capture the nuance or the inherent value of a medical encounter. The ensuing outcry could simply be added to all the other perceived outrages of our public healthcare debate.

Still, Spradlin pointed out that in the initial flush of reportage after April 9, reporters and healthcare critics were able to go after apparently inflated costs.

"It took all of about a day for them to start finding which providers had the highest billing numbers," Spradlin said. "But it certainly won't be the last word." Geographic variations, socioeconomic variables and other deep population analysis "may be the most interesting of all. Some of that could come out of this competition. People will be analyzing this data for months and months. I think the least interesting thing is actually what got published on April 10."

Every time more of this data gets released, a network effect will kick in, with new opportunities to correlate previously-released data with the new.

In a world where consumers can spend five hours picking out their latest smartphone, and less than 20 minutes picking a physician, this kind of information will fundamentally change healthcare, Spradlin said.

"The AMA is right, in that there is a lot of context that's important to understand," Spradlin said. "As we get a little bit smarter, and the consumer population gets a little bit smarter about understanding and parsing a lot of this, we'll get better at correlating the quality measures in these cases.

"I also think we could see some unexpected attempts at driving some that, even here. When you look at claims data, you can't help but look at readmission rates. Are readmission rates potentially a strong signal of quality? I think for certain procedures, probably."

Code-a-Palooza visualization proposals are due on April 25. (Don't worry, the coding doesn't all have to be done by then.) As competitors and other healthcare luminaries assemble in Washington June 1–3 and I'll be there again to cover it—then the real fun begins.