Purpose
To provide a status report on the Washington all payer claims database, to encourage you to review the claims data for your hospital, and to have a member of your staff participate in a WSHA webinar on September 26th.
Recommendation
The state, using its new all payer claims data set, will be unveiling new information to Washington consumers on the cost and quality at Washington hospitals and outpatient surgery/diagnostic centers. The information will be available on a public website late in the first quarter of 2018. It will show the median and range of allowed amounts for a set of services at your hospital compared to other Washington hospitals. The services will include 12 common inpatient procedures and 40 common outpatient procedures. Outpatient procedures include such services as colonoscopy with biopsy and mammography screening. Inpatient procedures include services such as lumbar fusion (severity level one and two), vaginal delivery (severity level one). Allowed amounts include both the hospital and physician service provider claims.
This information is being developed from data provided by commercial insurers. It will include allowed claims information from the period from the 2015 through 2016 period. It will also have comparative information on quality that the state derived from publicly reported quality measures included in the state’s common measure data set.
You will be given a chance to review the data for your hospital to check the accuracy of the data set provided by the insurers. Your hospital will be able to view the summary claims records being used to derive the price information starting in late-November. The five week review period will end in early January. Your hospital needs to designate a staff person to serve as the point person for the review process by October 6. A staff person whose responsibilities include commercial payer reimbursement and/or pricing of medical services is well suited to this role. This person can register here.
It is important to realize that whether or not you opt to review the data, your hospital information will be included on the website and in the database. We encourage you to scan the claims data set for reasonable accuracy. We think it may be difficult to do an actual claim-by-claim check of the specific claims data you receive, but encourage you to at least to do a general review. We also encourage you or your staff to register here and participate in a webinar hosted by WSHA on September 26th from noon to 1:00 p.m. The webinar will have the program lead for the state’s project available to provide general information and address questions.
Background
In 2015, the Washington State legislature established the state’s all payers claims data set. Under the Washington Office of Financial Management, the state contracted with the Center of Health Services Effectiveness at the Oregon Health and Sciences University to develop the APCD. The APCD is intended to provide information to consumers on a public website on the cost and quality of health care services.
The data set is also available for a fee to researchers, public agencies, and other entities, with specific protections to guard patient privacy and protect proprietary financial information. Proprietary financial information is defined as claims data or reports that disclose or would allow the determination of specific terms of contracts, discounts, or fixed reimbursement arrangements or other specific reimbursement arrangements between an individual health care facility or health care provider, and a specific payer, or internal fee schedule or other internal pricing mechanism of integrated delivery systems owned by a carrier.
Because of the protections on proprietary financial information, the public use website will not provide information on allowed amounts for any service at a hospital in which a single commercial payer has a dominant market share such that the payer could be readily identified.
Additional References
Legislation: http://app.leg.wa.gov/billsummary?BillNumber=5084&Year=2015
WA APCD Performance Review Frequently Asked Questions:
http://www.ohsu.edu/xd/research/centers-institutes/center-for-health-systems-effectiveness/wa-apcd-governance-information/Review-and-Reconsideratioin.cfm
