Counterpoint: Medicare Data Flood Useful, Just Not To Average Patient Yet

Source: Dr. Farzad Mostashari, Engelberg Center for Health Care Reform, The Brookings Institution

Source: Dr. Farzad Mostashari, Engelberg Center for Health Care Reform, The Brookings Institution

For a moment there, it looked like a point-counterpoint clash of health-policy views, based on this post: Deluge of Medicare data: Is it useful? Well it’s a step.

Dr. Darshak Sanghavi, a distinguished Massachusetts-based doctor/author who is now a fellow at the Engelberg Center for Health Care Reform at the Brookings Institution, tweeted that he was “not on board with that view.” (The view that the great recent gush of Medicare data is not very useful. At this point, anyway.)

Turns out, though, that Dr. Sanghavi is quite willing to stipulate that, as he put it when we spoke today, “It is highly unlikely that the average patient can do much with Excel spreadsheets containing millions of line items with medical codes.” So from the patient’s point of view — our usual CommonHealth vantage point — he agrees.

But he adds a big “however.”

“However, having said that, I think part of the challenge now is: What should people who have data-crunching skills — whether private industry, regulators, government officials and others — now that the data is out there, what business case can be made for them to do that work for you?”

“I think the key consumer here is not the patient — tens of millions of spreadsheet entries are not going to be valuable to patients. But this is exceedingly valuable to insurers now. Insurers know what their claims are now, but there’s a very competitive insurance marketplace. As an insurer you only know, say, your 5 or 10 percent of the market, but now that you have Medicare data, you can say, ‘That’s really weird. On Medicare patients, they’re only doing steroid injections on one patient out of 10 or whatever, whereas on my covered patients, they’re doing it on 50 percent. Why is that? Is it because I’m paying a different rate than Medicare? Are my incentives screwed up? Should I be rethinking how I do pricing and contracting? Or is there some really good reason?’ You can see what is price-sensitive behavior on the part of providers in a way you couldn’t see before. So that’s very valuable, if you’re a private insurer.

“Now suppose you’re a public health researcher. You can now say, ‘Okay, I’m interested in having better roads so people can bike more, and I can now, for the first time, pull data showing that patients over 65 in my area have unusually high rates of diabetes complications, as opposed to other areas, because I can now look at geographic variation as well.’ In that case, maybe your town should devote a little more resources to thinking about how we should be handling this. I’m speculating, but it shows you where hot spots are for certain kinds of disease patterns, and lets you focus your efforts in a way you couldn’t before.”

“And suppose you’re an employer, so you’re responsible for a fair number of your own health care costs. Because, as an employer, you pay different rates to private insurance carriers like Blue Cross, you might be interested in seeing, what are the Medicare rates and total use, how much are people charged for these patients? And does the premium I’m paying make sense? Should I renegotiate in some way?”

The key insight, Dr. Sanghavi said: “This is not data for everyday people. It’s really a resource for others and what they can do with that.”

Although…he also mentioned an interesting case based on the slide above, which was presented by Dr. Farzad Mostashari, until recent the federal chief of health information technology. Dr. Mostashari needed to find a doctor to see his mother for back pain. So he analyzed the data to determine how many times various doctors billed for steroid injections for back pain, which can be an alternative to surgery.  The doctor who did 263 injections “might be somebody who would be the best person to go to,” Dr. Sanghavi said, “because it seems like he’s really interested in talking to patients, saying maybe you should try physical therapy and an injection and only then consider surgery.” Dr. Mostashari made his mother an appointment with the doctor who’d done the most injections.

If you want a glimpse of the kind of data-mining already getting under way, the Brookings held an event last month called “Hacking America’s Health” and has posted the slides here.

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