HD16 - A Study of a Consolidated Health Care Data Base in Virginia
Executive Summary: The health care system in the United States and in Virginia appears to be undergoing rapid and profound changes in organization, behavior of providers, and patterns of utilization. Recognizing the increased need for information about the health care system created by current changes in health care, and recognizing that there are significant deficiencies in existing health care data, the Joint Subcommittee Studying the Feasibility of Preserving a Regional Health Planning Mechanism in the Commonwealth introduced House Joint Resolution 27 in 1984, which called for a study of the feasibility of establishing a consolidated health care data base for Virginia. A truly consolidated health care data base for a state is almost beyond imagination, certainly beyond feasibility, due to the volume of data, the number and variety of sources involved, and the lack of uniformity with which data are recorded and facts are classified. The practical question then is where effort can best be directed to improve the availability and usefulness of health care data. Hospital services and physicians' services provided in hospitals account for more than half of the nation's health care expenditures. Virginia and most other states have recently established a uniform billing document or billing format, known as UB-82, which must be used for nearly all hospital inpatients and a majority of emergency room and other hospital outpatients. The UB-82 data set could serve as the principal or sole source of input data for a statewide hospital patient data base. Such a data base would not provide data on hospital expenses, which are already collected and analyzed by the Virginia Health Services Cost Review Commission, and which are based on a different set of forms and procedures for reporting and analyzing financial data. A more uniform accounting or financial reporting system for hospitals does not appear to be practical or necessary or particularly relevant to the principal data need identified in this study. Statewide hospital patient data bases have been established or are being established in a number of states. Six such data bases (Iowa, Illinois, Maine, Maryland, Massachusetts, and New York) are described in this study. Most of these are operated by private, not-for-profit corporations. Two were organized as consortia of various parties involved in the health care field. However, only one of these data bases depends on voluntary reporting of data, and most of the data which it receives is required to be reported to a state agency anyhow. Annual expenses of these data base organizations are reported to range from about $100,000 to about $500,000, depending on the nature and volume of input data and the scope of services provided. Maintaining appropriate confidentiality of information in a hospital patient data base is an important concern. While there is universal agreement that data must not be released to data users in a manner which identifies individual patients or indirectly permits their identification, there are important differences among existing data base organizations in the procedures for accomplishing this. Issues of confidentiality with respect to physicians and institutions are quite different than with respect to patients, since a principal reason for developing a hospital patient data base is to identify variations among providers -- especially among hospitals -- in patterns of utilization of health services and charges for these services. Identification of physicians should probably be handled differently from identification of hospitals. This paper presents views from various sources, including state legislatures, a national association of major employers, the industry association of commercial health insurers, and health care researchers, showing that a hospital patient data base can contribute to improved public and private decisions about the provision and use of health services, so as to reduce the growth of expenditures while maintaining or increasing quality, accessibility, and patient satisfaction with care. These views are shared by the health system planning agencies in Virginia. It is recommended that the Commonwealth move forward with the establishment of a statewide hospital patient data base and that the General Assembly adopt a resolution directing the following actions: • That the staff of the Department of Health, in conjunction with other state agencies (Virginia Health Services Cost Review Commission, Department of Information Technology) proceed with more detailed investigation of the principal issues identified here and of the operation of such data bases in other states. • That State staff have detailed discussions with the Virginia Hospital Association, the Medical Society of Virginia, health insurers, and employer groups concerning their views about and participation in a statewide hospital patient data base. • That staff prepare a report, based on the foregoing investigation, setting forth detailed recommendations, including estimates of revenues and expenses, concerning the establishment of a statewide hospital patient data base. It is further recommended that the General Assembly appropriate $15,000 to carry out the investigation and prepare the report described above. |
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