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Mass. Hospitals Balk At Fees To Access Trove Of Medical Claims Data

The state’s painfully wonky sounding All-Payer Claims Database (APCD) — a catalog of medical, dental and pharmacy claims, as well as other patient-related information — is truly tantalizing in its potential.

For researchers, tapping into this recently released data — a centerpiece of the newly created Center for Health Information and Analysis and part of the state’s overall plan for health care reform and cost control — can offer “a deep understanding of the Massachusetts health care system by providing access to timely, comprehensive, and detailed data,” according to the APCD website. It promises to “be an essential tool to improve quality, reducing costs, and promote transparency.” (Though not necessarily for the average patient: basically, you need an analyst by your side to really comprehend the trove of complex information.)

(401(K) 2012/flickr)

(401(K) 2012/flickr)

But wait a minute. To access this important data for one year will cost a mid-size organization, like a community hospital, about $40,000, according to the Massachusetts Hospital Association, which argues that the fees are too high. “We’re very disappointed,” says the MHA’s Senior Director of Managed Care, Karen Granoff. “I think [the pricing] is going to discourage many providers from trying to access it.”

The Center For Health Information and Analysis says the proposed fee schedule is based on four factors:

(1) the type applicant requesting the data; (2) the type and number of data files requested; (3)the data elements requested; and (4) the number of years of data requested. The Center may reduce or waive the applicable fees for qualified applicants.

(Also, the final fee schedule is still being determined. It’s slated for release around June 1.)

Still, in written testimony to CHIA earlier this month, the hospital association argued that the proposed fee structure is simply unmanageable, particularly when the state is pressuring hospitals and providers to re-invent themselves as Accountable Care Organizations and to provide less costly and higher quality care and patient management.

“It would be an unintended consequence if the Commonwealth’s multi-year, ambitious effort to control healthcare costs were to fail due to barriers to data access set up by the agency itself,” Granoff wrote.

But hospitals already have all the claims data on their own patients, right? So why the brouhaha over the more comprehensive claims data? Here’s why the information is important, says Granoff:

The purpose of APCDs is to support health care transparency, health care reform initiatives, and improve care for patients. Access to data from all payers (commercial and government) will be vital to the successful development of ACOs and other integrated models of care. While it is true that providers may currently have access to data from one payer at a time, the timeframes, content, frequency, and ability to mesh data from different sources does not exist outside of the APCD.

The legislature recognized the importance of the APCD to providers when it included language specifying that:

“CHIA shall, to the extent feasible, make data in the APCD available to payers and providers in real time. Providers and provider organizations, among others, be permitted to have access to de-identified data for the purposes of lowering costs, coordinating care, performing quality analyses, and for administrative or planning purposes, etc.
Providers and provider organizations be given access to data with patient identifiers for the purpose of carrying out treatment and coordinating care.”

Regarding the APCD and its use by providers, it will allow performance analysis based upon previously unavailable data from private and public health insurance plans, including

*Follow-up after medical or surgical hospitalization
*Readmission rates Continue reading