Minn. health care ratings group plans to examine newly available Medicare data

The federal government announced Monday that it would allow its Medicare claims database to be used by employers, insurance companies and consumer groups to help rate local doctors.

The information has been off-limits in the past, but President Barack Obama's health care overhaul law authorized its release. The hope is that the massive amount of data will help local organizations create report cards on doctors.

One of the Minnesota groups that will apply to use the data is Minnesota Community Measurement. Its president, Jim Chase, spoke with MPR's Morning Edition.

Cathy Wurzer: How do you plan to use this data once you get it?

Jim Chase: We think this will be very helpful. We've been reporting these kinds of measures in Minnesota for the last seven years, and one of our big gaps has been Medicare information. So we've been reporting on things like cancer screening, diabetes care, heart disease, depression, and this should be very helpful since there are many people who have Medicare coverage that we can now get information with.

Wurzer: How long have you been trying to get access to this kind of information?

Chase: This has been going on for quite a while. We had a project with Medicare about five years ago where we tried to do this, and ran into a problem with the law that didn't allow it. So it's been in the works now for many years. To get this released both in a way that makes sure patient data is kept secure but also that it's done in a way that's fair to physicians.

Wurzer: What kinds of things will you look for?

Chase: We'd look for where there is a variation in outcomes for patients across conditions, like heart disease or another great example for us right now that this data will allow us to do is look at hospital readmissions. We know one of the problems we have is some people who get discharged run into problems in their care and then they're right back in the hospital, which isn't good for anybody. A lot of those people are covered by Medicare, and no one clinic or hospital or physician has all that information about that patient. So this information will be really helpful to improve the care they're receiving.

Wurzer: Some of the very best doctors take on some of the very worst cases? Couldn't that skew data for those doctors?

Chase: That's why it's been important to have experience in working with this data over time. In releasing this data, Medicare is saying it's only going to give it to groups like us that have some experience with this because we realize we have to do some things around risk adjustment to make sure that it's fair for everybody when you're presenting the data. We've got a pretty robust process where we're working with clinicians to identify what the measures would be. We don't always get 100 percent agreement but we get pretty good agreement across the market about what we put out being fair and reasonable for people to look at.

Wurzer: How could this potentially lower health care costs?

Chase: They're looking for anyone using the data to not just look at quality but also look at cost of care and areas where that could be improved. Readmissions is a great example where that could be effective, where when we reduce the readmissions we also reduce the costs that go with it.

Wurzer: And you see this leading to better patient care long term when you see these measurements?

Chase: Absolutely. We've already had good success in Minnesota doing that in some areas like heart disease and diabetes and depression. We hope to be able to expand that into other areas that will benefit patients across the state.

Wurzer: What will be some of the pitfalls from looking at this data?

Chase: There's a lot of information there and being able to manage it well will be a challenge, as well as making sure we have a process that verifies the results before we publish it. We put that in place so there's an appeals process for clinicians that are being reported on. Also making sure patient identifying information isn't accessed at all.

Wurzer: Do you see patients using this data to find another doctor that has better outcomes at a cheaper rate, or selecting a hospital?

Chase: People are beginning to use that on our site already. A lot of people are looking at our data when it's open enrollment time when they're making choices about their health care for the year. As we get more data we hope that it will be more useful for people — both where can you get the best outcomes for the care but also at the best price.

Wurzer: What else do you want to add about this effort?

Chase: It's good to see this happening. This has been an important piece for us here but also across the county. It's a good recognition in Washington that this kind of work has to go on in communities. They can't generate reports in Washington that will be effective. It's really getting the reports out and getting it used with the physicians that makes the difference.

(Interview transcribed by MPR reporter Elizabeth Dunbar)

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