Maryland Data Collection Effort

[Mark <mparham@erols.com>]

  Health Care Access and Cost Commission Response to postings re: Maryland
  Medical Care Data Base...
  
  
  	There are many misconceptions about the Maryland Medical Care Data Base
  finding their way to this arena.  Here is some truth.
  
  	The General Assembly authorized the collection of the Maryland Medical Care
  Data Base in 1993 in response to the need for accurate and reliable data on
  health care expenditures.  With this information, they felt they would be
  better able to make informed public policy choices about health care for
  Marylanders.
  
  	The Health Care Access and Cost Commission (HCACC) is statutorily
  authorized to collect:
  	 	demographic characteristics (age, sex, zip code)
  	 	principal diagnosis
  	 	procedure performed
  	 	date and location where procedure was performed
  	 	charge for the procedure
  	 	whether the bill was submitted on an assigned or unassigned basis
  	 	practitioner's identification number.
  
  	Note, the Commission is not and will not collect a patient's name, address
  or unencrypted patient identifier.  By regulation, the Commission is
  collecting a patient number that is encrypted by the third party payor.  The
  Commission is never given the key to decrypt the number.  The purpose for
  assigning the encrypted number is to remove duplicate claims, edit the data
  and check their accuracy.  The Commission supports the idea of removing the
  encrypted identifier after the data has been edited.  Without some form of
  identifier, which is not traceable to a particular person, but rather to a
  particular encounter, the data collected would be severely flawed, and would
  be unable to provide the information that the Legislature has authorized the
  Commission to collect.
  	
  	Although the data base currently contains the day, month and year of birth,
  the Commission supports Senate Bill 529/House Bill 1031 which limits the age
  information to only month and year.
  
  	The information contained in the data base is obtained from third party
  payers on computer tape.  It is not submitted via electronic submission, and
  the Commission, after studying the possible confidentiality and cost
  ramifications has determined that electronic transfer of data should not be
  undertaken.  It is not an on-line database, and is therefore not vulnerable
  to computer hackers.
  
  	The enabling statute authorizes the Commission to collect data on health
  services "rendered by health care practitioners and office facilities."
  Practically, however, the Commission has only collected information from
  third party payors, not from individual providers.  Because it does not
  intend to do so, the Commission supports Senate Bill 530/ House Bill 1030
  which limits the Commission from obtaining information on self-paying
  patients.  The Commission feels that many in the mental health arena will
  agree that self-pay patients may feel more comfortable knowing that their
  information, even though it is encrypted and unidentifiable, will not be
  collected.
  
  	The Commission hopes that the information included here will go far to
  dispel some of the misconceptions about our activities.  Many policy makers
  and residents believe that the information that is being collected is vital
  if we are to understand the costs and utilization of health care services in
  Maryland.  Following this posting is a fact sheet prepared by the
  Commission.  Please read it.
  
  	The Commission encourages all interested parties to obtain a copy of the
  Annual Report on Expenditures and Utilization from: 
  	Maryland Department of Health and Mental Hygiene
  	Health Care Access and Cost Commission
  	4201 Patterson Avenue
  	Baltimore, MD  21215
  
  	It is also available at the Department of Mental Hygiene's home page:
  	
  	Http://www.charm.net/~epi9/report1.htm
  
  
  	
  
  Posted by:
  Mark L. Parham
  Health Care Access and Cost Commission
  Assistant Chief EDI Programs and Services
  
  
  
  -------------- Data Collection Fact Sheet
  
  	
  
  
  
  	HCACC Data Collection Fact Sheet
  
  1. Why is the HCACC collecting information about medical expenditures?
  
  	In 1993, the Maryland General Assembly passed legislation creating the
  Health Care Access and Cost Commission ("HCACC," or "the Commission").
  Much of the debate on health care costs and access has occurred in a vacuum
  of reliable and accurate information.  This is particularly true of
  non-hospital services.  Among its many duties, the HCACC was required to
  create the Maryland Medical Care Data Base. (Health-General Article
  §19-1507).  The Commission is to report annually on the variations in fees
  charged and utilization of health care practitioner services.  The first
  report was released February 1, 1996.  The purpose of the report is to
  separate fact from fiction, thereby allowing purchasers and policy makers to
  make better decisions on health care spending.  In addition, with all of the
  significant changes occurring in our delivery system, this data base can be
  used to judge whether or not the changes have, in fact, improved access and
  lowered costs. 
  
  2.  What type of information is being collected?
  
  	In 1995, the Commission began with a voluntary program of data submission.
  Medicare and Medicaid -- the two major public payers -- and ten private
  sector payers supplied the Commission with claims information for 1992 and
  1993.  This information does not include patient names and addresses, nor
  does it include detailed clinical information from the medical record.
  Instead, the data include an encrypted patient identifier (to which the
  payer retains the key), along with charges, payments, procedures performed,
  and limited demographic information.  The HCACC requested that payers
  provide the encrypted identifier to assist in removing duplicate and
  adjustment billings that commonly exist in such databases.  Were these edits
  not applied, there could easily be double or triple counts of services.  The
  Commission has recently adopted regulations that will require third party
  payers to submit similar claims information beginning in 1997. (COMAR
  10.25.06).  In order to further protect the anonymity of the information,
  the HCACC supports legislation that will require the submission of  only the
  month and year of birth.  The payers will submit information on all
  fee-for-service encounters (whether primary care or specialty care) and
  specialty care encounters in which the provider is paid by capitation.  All
  of the data items collected are authorized by the Commission's enabling
  statute. 
  
  3.  Will the Medical Care Data Base place additional burdens on Maryland
  physicians and other providers?
  
  No.  The Medical Care Data Base includes information currently submitted by
  providers to payers.  All providers paid on a fee-for-service basis submit
  HCFA 1500 forms to payers.  Similarly, payers know if a patient has been
  seen by a specialist paid on a capitated basis from existing referral forms.
  Some providers may be experiencing new data collection requirements from
  HMOs because the business community is demanding quality measures known as
  HEDIS (Health plan and Employer Data Information Set). The HCACC is also
  collecting HEDIS information to construct HMO report cards.  However, the
  demand for data to document these quality measures would not end if the
  HCACC stopped the report card project.
  
  
  4.  What is the HCACC doing to protect confidentiality of the information?
  
  	The Commission takes its responsibility to protect the confidentiality of
  this information very seriously.  The Commission is required by law to
  protect the confidentiality of the information it is collecting.  There is
  specific statutory reference in the HCACC's enabling statute to protect the
  data (Health General Article §19-1507©  and §19-1511(a)).  The Commission is
  also bound by the provisions of the Maryland Medical Records Act (Health
  General Article §4-301 et seq.).  As indicated earlier, in its initial data
  collection phase, the patient identifying number is encrypted by the payer.
  The Commission has also established procedures to severely limit access to
  the information and to bind its employees and contractors who have access to
  the data to strict confidentiality protocols.  The Commission has a range of
  options available, including prosecution, if an employee or contractor
  violates the procedures.  Although no security plan is foolproof, the
  Commission believes the procedures and processes provide ample safeguards.
  It should also be noted that neither the Commission nor the contractor
  supports dial-up access; it is not possible for a hacker at a remote
  location to gain access via a modem and telephone line. 
  
  5.  Is the State creating an "on line" Medical Record
  
  	No. The Commission does not have the authority to create an "on line"
  medical record.  There may be private sector health care institutions and
  payers that are creating such medical record systems, but the State of
  Maryland is not part of those efforts.  As noted above, the Commission is
  collecting certain medical billing information and not the complete medical
  record.
  
  6.  What are electronic claims clearinghouses, and what oversight is the
  State providing those organizations?
  
  	Electronic claims clearinghouses ("ECCs" and sometimes referred to as
  electronic health networks or "EHNs") are private sector organizations that
  facilitate the electronic submission of claims information to third party
  payers.  These organizations have developed over the last several years as a
  means to lower the administrative cost of health care by providing
  physicians and other health practitioners with a single source through which
  they may submit their claims information to third party payers.  The HCACC's
  enabling statute requires the Commission to regulate these entities.  The
  HCACC has proposed regulations that would establish standards for ECCs to
  become certified in Maryland. The proposed regulations will use national
  accreditation standards plus stringent State regulations on confidentiality
  to help impose additional controls on these organizations.    Although the
  HCACC has the authority to require providers and payers to submit claims
  information electronically, the Commission has instead opted for a voluntary
  approach in which providers can choose to submit their claims to payers
  electronically. The HCACC's role is to set standards for these private
  sector organizations to follow.  At the same time, the HCACC has begun an
  Electronic Data Interchange initiative that will help encourage the adoption
  of electronic claims submission.
  
  7.  What about information on self-paying patients?
  
  	The HCACC is not collecting any self-pay data at this time, and it voted at
  its 2/1/96 meeting to support legislation banning the collection of self pay
  encounter level data.  In order to more fully address issues of privacy and
  confidentiality, the HCACC appointed a 16 member advisory committee on
  privacy and confidentiality.  Although this advisory group will continue to
  meet to discuss other related issues, the Commission's recent vote
  effectively ends any further action on self-paying patient information.
  Sincerely,
  
  Mark L.  Parham
  Asst. Director, EDI Programs and Services
  Health Care Access and Cost Commission