Physicians in Washington state say they would like to support a new regional healthcare quality study, but they remain wary of the limited time and funds allotted to the program, according to W. Hugh Maloney MD, president of the Washington State Medical Association.
The study, to be updated quarterly and slated to be publicly released sometime this year by the non-profit Puget Sound Health Alliance, will involve de-identified claims data from 15 area health plans, self-insured employers and union trusts, amounting to information on 2 million lives, the Alliance announced March 10.
The doctors, who have participated in the Alliance project from the beginning and support the effort to improve healthcare quality and contain costs, would like to have a way to check the data for accuracy, Maloney said. But the difficulty comes with using de-identified claims data.
The Alliance has allotted 60 days for doctors to verify the "reasonableness" of the data and another 40 days to resolve differences, according to Diane Giese, spokesperson for the Alliance. Plans are still underway as to how doctors might verify the reasonableness of the data without access to identifiable information. One idea is to allow doctors to verify how many patients they have with a certain chronic condition, thus providing some sense of the reasonableness of the study, Giese said.
"Some doctors said we should take years for this study; purchasers wanted it yesterday," Giese said. "Finding the balance is difficult, but we can't slow down progress. If we waited for perfection, none of this would happen. We're doing the best we can. We will refine it over time."
But doctors in Washington have already had a negative experience with such studies. Among the health plans to participate in the Alliance project is Regence Blue Shield. Washington State Medical Association and six of its physician members and the American Medical Association filed a lawsuit against Regence last fall for damages over what the doctors say are violations of the Consumer Protection Act, defamation, libel, intentional interference with commerce, and breach of contract.
WSMA claims Regence conducted a flawed study based on inaccurate information that resulted in Regence excluding 500 physicians from its select network of high performance physicians.
Of the Puget Sound Health Alliance Report, Maloney said the most accurate way to create a performance report would be to go through physician chart notes to verify and expand claims data, an expensive and time-consuming venture. Some of the instances of data in the Regence case involved, for example, doctors who didn't ask a woman with a mastectomy to get a mammogram.
"The major issue at hand is that doctors are going to have outcomes reported for data they've never seen, although this data comes from their offices," Maloney said. "These are highly trained doctors who have dedicated their lives to taking care of their patients."
Last January, Department of Health and Human Services Secretary Michael Leavitt hailed the Puget Sound Health Alliance as a community leader in promoting healthcare transparency. HHS is expected to grant Medicare data to expand the Alliance's study, making it the first in a national network of local organizations to have access to Medicare data for transparency studies, Leavitt said.
The State of Washington Uniform Medical Plan will contribute data from 170,000 lives to the study, according to Janet Peterson, executive director of the Uniform Medical Plan. Privacy for patients' data was a significant concern, but with some work, was satisfactorily nailed down in the contract with the Alliance, Peterson said. She expects the report to be invaluable.
"There are so many different directions people are going with trying to improve quality of care, to have a common consensus on priorities and standards is going to be incredibly important for minimizing the administrative burdens," Peterson said.