Purpose
We are emphasizing the importance of your participation in the review process being offered by the state’s All Payers Claims Database (APCD). This is your chance to review and reconcile data that will be made public on the “cost” and quality of your facility and the quality of your primary care practices. Once the information is released to the public, there will be no opportunity to review it until the next APCD public data release later in 2018.
Applicability/Scope
The APCD is launching a consumer based website. It will display by hospital the median all-payer allowed amounts for selected inpatient and outpatient procedures. (Specialty hospitals are excluded and some small hospitals with an insufficient number of patients for a specific procedure may be excluded.) For comparison purposes, the website will also show the allowed amounts for outpatient surgery and diagnostic facilities. Hospital quality measure results will be reported for a small number of measures sourced from CMS Hospital Compare and WSHA data. In addition, the website will display quality ratings for primary care practices with four or more physicians.
Recommendation
In mid-January, hospitals and provider organizations which have registered with the APCD will have the opportunity to review and correct their data. Hospitals and providers have a month to perform the review. We strongly urge that someone at your hospital open the dataset and determine if the data look reasonable for your facility and/or practice.
Overview
Hospitals, outpatient facilities, and primary care practices have a chance to review information that will be provided by the state to consumers through the public website. The website launch is scheduled for the end of the first quarter of 2018. It will display the median and range of allowed amounts for a set of services at your hospital compared to other Washington hospitals and facilities. The services include about 75 common inpatient and outpatient procedures.
The allowed amount information is developed from data submitted by commercial insurers. It includes claims information from 2015 and 2016. The website will also have comparative information on quality derived from publicly reported quality measures included in the state’s common measure data set.
All but 14 hospitals have registered to be part of the review process. Participating hospitals have identified a person as their primary reviewer. If you have not yet signed up to participate, you can contact the APCD staff at wa-apcd@ohsu.edu.
The website also will include information that reports the quality of care at primary care practices with four or more physicians. Primary care practices have a chance to review and reconcile information. A key consideration in this review is whether the attribution of the physicians and other practitioners to the practice is accurate. Beginning in early December, the APCD circulated practice rosters to medical practices. Practices that confirmed or corrected the rosters as of December 15 will see the quality results based on these changes. Others can make roster changes during the upcoming review period. A significant number of primary care practices have not yet signed up to be part of the review process.
It is important to realize that whether or not you opt to review the data, your hospital and primary care practice information will be included on the website and in the database.
Next Steps
- Make sure your hospital has registered to review the data for your facility, and if applicable, your primary care practice.
- Carefully review the APCD data use agreement which is being circulated to all registered hospitals the week of December 18. This agreement must be executed electronically as the first step in accessing the data for review in January.
- Anticipate the APCD data will be available in mid-January.
- When the data are available, review the data provided to see if it is reasonable for your facility. If your facility operates a primary care practice, check the attribution for the physicians included in your facility’s primary care practice.
- Make corrections as appropriate to the database.
- Contact WSHA staff if you notice significant discrepancies so we too are informed about potential issues.
- Understand how your hospital compares to the statewide averages on cost and quality for the selected procedures.
- Understand if you will need to respond to press about any of your quality or “cost” information once the website is open to the public.
Background and References
APCD Staff Answers to Frequently Asked Questions:
Originating State Legislation: http://app.leg.wa.gov/billsummary?BillNumber=5084&Year=2015
