Prepare to give away financial data and pay your state for the privilege’
More states are jumping on the bandwagon: Is yours next?
The phrase "taxation without representation" might raise images of the Boston Tea Party and other events from the American Revolu-tion. However, some same-day surgery managers say they feel a bond with those revolutionaries as an increasing number of states force providers to collect and submit financial data against their will. Further-more, some states require providers to pay for submitting that data — and the cost is as much as $1 per claim.
While hospital-based same-day surgery programs usually are accustomed to submitting financial data, the trend of including same-day surgery centers in those data collection activities has many managers up in arms. The reason: Surgery centers are required to share data that they consider proprietary. Most recently, the Nebraska legislature has looked at a bill, the Outpatient Surgical Procedures Data Collection Act (LB 1195), which would create a database of outpatient surgical financial data. (See story about states that are collecting data, p. 110.)
"In health care, unfortunately, you can’t go have your hernia fixed or plastic surgery or have tubes put in your ears to see what the competition is like. And so we see LB 1195 as perhaps an attempt to get around that problem," said Dale Michels, MD, immediate past president of the Lincoln-based Nebraska Medical Association, in testimony before Nebraska legislators. The bill is postponed while ambulatory surgery groups and the hospital association meet to discuss their differences, sources say.
Outpatient surgeons aren’t opposed to health data collection, Michels emphasized. "But it doesn’t seem to us that trying to determine the number of procedures performed is really of significance as far as the public health is concerned, and really becomes more of interest to the competition."
Same-day surgery managers agree that states have little need for such information.
"What do they do with it? They collect it, put it in a box, and store it," says Fran Thompson, administrator of the HealthSouth Surgery Center of Auburn (CA).
For their part, hospitals say they need the data for several reasons. One is to monitor health care expenses.
"We need information to have tools to look at the need or absence of need for services, variation in physician practice and treatment patterns, conducting studies on medical effectiveness and patient outcomes, and what kind of resources are needed for those particular programs. This will, in turn, constrain unwarranted expenditures," testified Roger Keetle, registered lobbyist for the Nebraska Association of Hospitals and Health Systems (NAHHS) in Lincoln. He also testified regarding Nebraska’s proposed legislation.
This process is particularly important in Nebraska because the certificate of need (CON) requirements were eliminated in June 1999, he said. NAHHS put together a committee to determine the impact, Keetle added. "We wanted to know what’s going on; what’s happening in access, cost, quality; what information’s available. How is health care changing? How is it shifting? Are we really saving money with the repeal of CON? Are these surgeries any cheaper or higher? Who knows what’s going on? And we did an extensive look at trying to find out information and found out that we could find out absolutely nothing."
Medicare has extensive information about hospitals, Keetle said. "However, information on ambulatory surgery centers was of very limited value and expensive to obtain." Insurance companies said the information was proprietary and would not be released, he added. "So without this information, we’ve got a growing gap as more things shift to outpatient surgery."
While hospital associations and state representatives often say they’re concerned about quality, they usually want access to cost and revenue information, says Rhonda F. Walker, business development director at Lincoln (NE) Surgery Center. "Our administrator testified that we’re never opposed to sharing quality indicators, but this bill isn’t designed to do that," she says.
California had considered collecting quality data, which concerned same-day surgery managers. "No. 1, it is extremely time-consuming from an employee standpoint," Thompson says. Computerizing would have been costly, she maintains. "No one had those systems in place. The expense was horrific."
The charge for submitting the data in California originally was set at $2.50 per claim. "We were successful, through our lobbying and a great political campaign by [the California Ambulatory Surgery Association], to reduce that to 50 cents a submittal," she says.
The issue of expense is still being discussed in Nebraska. The hospital association has suggested that secondary data, such as insurance claims forms, serve as the principal data source so that medical records don’t have to be summarized, which is costly and burdensome, Keetle testified.
"Unlike these states [California, Wisconsin, and Arizona] that require expensive special reporting, this bill takes another approach," he said. "It proposes only to require the reporting of information that should already exist in electronic form or can be easily computerized."
Another issue is the confidentiality of the data, Thompson says. For example, states might collect information on therapeutic abortions. "Some centers don’t want to advertise that they do those," she says.
Before you drop everything to call your state association or lobbyist, keep in mind that data collection isn’t all bad, one source suggests. In Wisconsin, one surgery manager has used the data collection to her advantage by finding out median charges in her state and adjusting her centers’ prices as needed.
Like any consumer, Sherry Lynch, RN, BSN, MPA, manager of outpatient surgical services at Aylward Surgery Center and Groth Surgery Center in Neenah and Appleton, WI, can access her state’s data collection Web site (badger.state. wi.us\agencies\oci\ohci). She types in the ICD-9-CM code for a procedure, and the median charge is indicated. If the charges at Lynch’s facilities are significantly less than the state median, she adjusts her charges to be more in line with other facilities.
Unfortunately, the data are old, says Lynch, who serves on her state’s technical advisory committee. Currently, Wisconsin is distributing 1998 data. "The state has problems sorting data, and they’ve had some flaws in them."
However, providers can pay for specialized reports that contain more current data. In addition, providers can purchase specialized reports by zip code, such as number of procedures undergone by patients living in a specific area.
Starting the data collection was a struggle, Lynch says. The state had difficult finding qualified information technology persons to hire. Also, facilities had to obtain new computer systems and ensure the systems would write the necessary report, she says. Small surgery centers could submit a paper report, but they had to pay approximately $1 per page for doing so, Lynch says.
So what is Lynch’s overall outlook on the data collection? "It’s really depends on how they structure it. It hasn’t been as bad as we thought."
For same-day surgery managers who remain unconvinced on the virtues of data collection and who want to avoid a state law, work through your state associations to address any proposed legislation, Thompson suggests. Ensure a renowned lobbyist is pleading your case. The California Ambulatory Surgery Association hired a lobbyist who was originally a pharmacist and well respected, she says.
Jay Kiokemeister, DO, MPH, medical director of 900 N. Michigan Surgery Center in Chicago, says, "If you don’t have strong enough lobbying in your state, it’s going to be difficult to avoid something like this."
Collecting financial data for states goes against the grain of ambulatory surgery, which was created, in part, to avoid all the paperwork of the hospital setting, Thompson says. "Unfortunately, because of all the bureaucratic requirements, we are backsliding."
Sources
For more information on data collection, contact:
• Roger Keetle, Nebraska Association of Hospitals and Health Systems, 1640 L St., Suite D, Lincoln, NE 68508-2509. Telephone: (402) 458-4900. Web site: www.nahhsnet.org.
• Jay Kiokemeister, DO, MPH, Medical Director, 900 N. Michigan Surgery Center, 60 E. Delaware Place, 15th Floor, Chicago, IL 60611. Telephone: (312) 440-5150, ext. 308. Fax: (312) 440-5151. E-mail: [email protected].
• Sherry Lynch, RN, BSN, MPA, Manager of Outpatient Surgical Services, Aylward Surgery Center, 130 Second St., P.O. Box 2021, Neenah, WI 54957. E-mail: [email protected]. Telephone: (920) 729-3159. Fax: (920) 729-3165.
• Fran Thompson, Administrator, HealthSouth Surgery Center of Auburn, 3123 Professional Drive, Suite 100, Auburn, CA 95603. Telephone: (530) 888-8899. Fax: (530) 888-1464.
• Rhonda F. Walker, Business Development Director, Lincoln Surgery Center, 1710 S. 70th St., Lincoln, NE 68506. Telephone: (402) 483-1550. Fax: (402) 483-0476. E-mail: RWalkwe @lincolnsurgery.com.
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