• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Wisconsin Bill Proposes Creating Group to Review Hospitals, Doctors, Insurers

Posted on: Friday, 30 December 2005, 21:00 CST

By Guy Boulton, Milwaukee Journal Sentinel

Dec. 31--A proposed bill would let the state join a new organization set up to determine which doctors and hospitals provide the best care at the lowest prices.

The bill would clear the way for the state to become a member of the Wisconsin Health Information Organization, a partnership of health insurers, hospitals, doctors and employers. The group, announced last month, plans to analyze millions of health insurance claims to find out which doctors and hospitals are the most efficient.

Four of the state's largest health insurers have agreed to pool their claims data, which would not include patients' names.

"We are totally convinced that this is vital to our state," said Helene Nelson, secretary of the Department of Health and Family Services, which with the Department of Employee Trust Funds is supporting the proposed legislation.

The Assembly Health Committee and the Senate Health, Children and Families, Aging and Long-term Care Committee will hold a joint hearing on the bill Tuesday. The proposal is being sponsored by Rep. Gregg Underheim and Sen. Carol Roessler, both Republicans from Oshkosh.

Similar legislation was included in Gov. Jim Doyle's budget this year but removed by the Legislature.

The bill would allow the state to submit insurance claims data for state employees to the Wisconsin Health Information Organization's data warehouse. It also would allow the Department of Health and Family Services to help fund the new organization through an existing $70 a year fee paid by doctors.

The nine founding members each have pledged $150,000 over three years to the new organization. The fact that hospitals, doctors, insurers and employers have agreed to work together also could set apart the Wisconsin Health Information Organization.

"We are on a path that very few states are on right now," said Underheim, the state representative.

The new organization is an outgrowth of the Wisconsin Collaborative for Healthcare Quality. The collaborative includes hospitals, physician groups, employers and labor organizations.

In the Milwaukee area, its members include Columbia St. Mary's, Froedtert & Community Health System and the Medical College of Wisconsin as well as Advanced Healthcare S.C. and Medical Associates Health Centers, two large group practices.

The goal is to analyze the insurance data to determine who provides care more efficiently. That will mean looking at more than prices. What a doctor charges for an office visit, for example, means little if he or she makes the wrong diagnosis, orders several unneeded tests or doesn't provide preventive care.

The Wisconsin Health Information Organization also plans to track patients over a period of time, giving a more accurate gauge of costs rather than looking at one hospital stay or office visit.

For example, a doctor who sees a diabetic patient every few months initially may seem to have higher costs than other doctors. But if the patient remains healthy, the doctor may have lower costs -- and provide better care -- over the long term.

"This really is leading-edge stuff, said Nancy Nankivil Bennett , director of strategic health policy for the Department of Employee Trust Funds.

The group hopes to help eliminate waste in the health care system by developing standards for efficiency and making the information public.

One study published in the New England Journal of Medicine in 2003 found that patients did not receive the recommended care 46 percent of the time and 11 percent of the time received care that was not recommended and potentially harmful.

The biggest influence on the health care marketplace could come from publicly disclosing the results. That could spur hospitals and doctors ranking low in efficiency -- because of high costs or low quality or both -- to find ways to improve.

"It raises the bar," Nankivil Bennett said.

The information culled from the claims also would tell doctors and hospitals where they need to focus to become more efficient.

Determining which doctors and hospitals provide the best care at the lowest price will mean analyzing millions of insurance claims. Software can help but, developing accurate measures will take time.

"We don't have a true model to work from," Nankivil Bennett said. "We are definitely pioneering in a number of ways."

In all likelihood, it will take years for the Wisconsin Health Information Organization to set up and develop accepted measures of efficiency.

"I don't know how long it will take," Underheim said. "But smart people are going to figure this out."

The first step, though, will be setting up the data warehouse.

"We have put in place the infrastructure to get there," Underheim said.

Since the 1980s, hospitals have submitted copies of their insurance claims initially to the state and now to the Wisconsin Hospital Association, which sells it.

Since the late 1990s, doctors also have submitted copies of their claims to the state Bureau of Health Care Information and Policy. That information has been used infrequently, and the program was criticized in a state audit early this year.

"We were not getting the results we needed," said Roessler, the state senator.

The program is funded through the $70 annual fee paid by doctors. The proposed bill will end the program of collecting copies of insurance claims from physicians but keep the $70 assessment to pay for the state's share in the program's funding.

Roessler is optimistic the proposed bill eventually will result in consumers being able to get information on health care quality and price that is easily understood.

"We are intending to make a difference," she said.

-----

To see more of the Milwaukee Journal Sentinel, or to subscribe to the newspaper, go to http://www.jsonline.com.

Copyright (c) 2005, Milwaukee Journal Sentinel

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

Source: The Milwaukee Journal Sentinel

More News in this Category