- Report Published -
|Possible Establishment of a Patient Level Data Base|
|Virginia Health Services Cost Review Council; Virginia Health Planning Board|
|SJR 178 (1991)|
|By enacting Senate Joint Resolution SJR 178 (1991)(Appendix 1), the Virginia General Assembly has requested the Virginia Health Services Cost Review Council, in conjunction with the Virginia Health Planning Board, to study all aspects of the establishment of a patient level data base in Virginia. A patient level data base can be used in efforts to contain costs and improve the appropriateness of care. These objectives can be achieved by allowing providers, payers, and consumers access to information needed to make intelligent buying decision; to evaluate medical technologies and services; and to establish guidelines to improve treatment and limit unnecessary procedures. A patient level data base would also provide information regarding access to care issues and facilitate effective planning for future needs. Potential use by providers, payers, employers, state and local governments, and the general public was to be studied. The need for and efficacy of establishing state agency oversight to ensure full participation, accurate and timely reporting, proper information dissemination, and maintenance of patient confidentiality were also to be examined. The Virginia Health Services Cost Review Council and Virginia Health Planning Board were additionally requested to prepare a grant application for The Robert Wood Johnson Foundation's new grant program for states entitled "Information for State Health Policy". The intent of this grant program is to help states strengthen their health statistics systems, to support state policy making, and to aid in program development and management.|
Patient level data refers to treatment and charge information that is specific for individual patients. Information that can be collected in a patient level data base includes: patient demographic information (i.e. age, sex, and residence location), patient diagnoses, patient procedures, attending physicians, and facility charges for each procedure. Patient level data can be used to:
*Publish patient charges, by facility, for all Diagnostic Related Groupings (DRGs);
*Publish physician charges for all DRGs;
*Track rates of admissions by diagnoses in areas as small as a zip code area;
*Evaluate incidence of disease in an area;
*Evaluate the effectiveness of illness prevention programs; and
* Evaluate access issues.
Currently, thirty-five states have enacted legislation to provide for institution health data collection. Thirty-three of those states, not including Virginia, collect hospital patient level discharge data. Twenty-four of the thirty-five data collecting states collect both facility financial data and patient level data. Two states, of which Virginia is one, collect only facility financial data.
Patient outcome data can also be collected as part of a patient level data base. Outcome data measures the patient's condition upon discharge. It can be used to assign some measure of "quality" to care being provided. "Quality Indicators" could be used to implement "buy-right" health care purchasing strategies. Pursuant to such a strategy,k purchasers would reward facilities that provide high-quality, cost effective patient services by encouraging utilization of those facilities.
three states have enacted legislation to collect outcome data to measure " appropriateness and quality" of health care services. Currently, there are eight major proprietary computerized systems available for risk adjustment and severity rating.
In contrast to patient level data, the Virginia Health Services Cost Review Council currently collects facility financial information on an aggregate basis. Using its methodology, total charges (revenues are compared to total costs (expenses) in order to evaluate the reasonableness of charges. Total yearly facility utilization is reported to the Virginia Health Services Cost Review Council but no data are available regarding specific utilization for services or patient origins. Overall total charges are reviewed, but specific charges by diagnosis or procedure are not reviewed. The Virginia Health Services Cost Review Council does publish selected charges for Virginia hospitals and nursing homes in order to provide consumers with additional purchasing information.
As part of the analysis required by SJR 178, Howard M. Cullum, Secretary of Health and Human Resources, wrote to approximately 150 groups and organizations to solicit information, comments, and concerns regarding the establishment of a patient level data base in Virginia. Responses indicated general widespread support for the establishment of such a system, but many concerns were raised, including source of data, choice of collection format, confidentiality, and cost.
Several phone surveys to those states utilizing a patient level data base were undertaken to determine specific uses, operating expenses, capital expenditures, and future goals. Personal interviews and literature searches were also undertaken.
In June, 1991, both the Virginia Health Planning Board and Virginia Health Services Cost Review Council voted to support the establishment of a patient level data base. However, in its recommendations, the Virginia Health Service Cost Review Council urged that there be adequate advance planning prior to key decisions being made for establishing such a system.
The Commonwealth also submitted an application on July 30, 1991 for funding to The Robert Wood Johnson Foundation's new grant program entitled "Information for State Health Policy". Governor L. Douglas Wilder appointed the Office of the Secretary of Health and Human Resources as the lead agency for the grant application. Pursuant to grant guidelines, an interagency working group, consisting of public and private agencies and organizations, was created. Its purpose will be to establish a coordinated and systematic planning framework for addressing the health policy and planning issues facing the Commonwealth, including the establishment of a patient level data base. In early October the Foundation notified Secretary Cullum that Virginia was not chosen as one of the recipients for a grant. Secretary Cullum, however, has indicated his desire to initiate the planning process as described in the Foundation's grant application.
Given the general widespread support for establishment of a patient level data base, while being mindful of the complexities and concerns which are involved in such a process, it is recommended that the Commission on Health Care for All Virginians indicate its support for establishing such a system. It is further recommended that the Commission require the Secretary of Health and Human Resources to utilize the committee and planning structure established in The Robert Wood Johnson Foundation's grant application, with input from the Virginia Health Services Cost Review Council and the Virginia Health Planning Board, to develop a detailed, systematic plan for establishing a patient level data base in Virginia. The Secretary should be requested to report to the Commission by October 15, 1992 regarding this planning effort including proposed legislation needed to establish a patient level data base in Virginia.