February 7, 2013
California health regulators should begin collecting physician identifiers as part of their routine data collection efforts about the services provided at the state's hospitals, according to a new RAND Corporation report.
Such a move would help health providers improve quality by aiding efforts to benchmark performance and reduce variations in the delivery of care. It also would offer consumers and health care payers additional information about the medical services offered by the physicians who deliver care in California hospitals, according to the report.
“Every other state that collects hospital discharge data is already collecting physician identifiers, so California is lagging in having information to drive quality improvements,” said Cheryl Damberg, the study's lead author and a senior policy researcher at RAND, a nonprofit research organization. “Making this change not only can help providers identify opportunities for improvement, but also has the potential to provide California consumers with information to help them choose health care providers.”
California is unique among the 48 states with hospital discharge reporting programs because it does not collect details about physicians. States collect information about hospital care to gain insights about cost and quality of medical care delivered at the institutions.
The California HealthCare Foundation asked RAND to examine issues associated with including physician identifiers in the California hospital discharge data program and the potential uses of physician-linked information by the state and/or release for use by others.
Researchers interviewed a broad set of California stakeholders, and reviewed the legal and regulatory standing of the Office of Statewide Health Planning and Development to make such a change. They also interviewed representatives of other states to understand any issues associated with the collection and release of physician-identified information.
Researchers concluded there was no significant reason why California should delay in including physician identifiers in the discharge information it collects on all hospitalizations. Moreover, California hospitals already report such information to both the federal Medicare program and to many private insurance companies in order to receive payment for services delivered.
Once physician information is collected, officials must determine how much of the information to make public and in what form. For example, efforts to produce physician report cards will need to make adjustments for many factors, including the severity of patients' illnesses.
Researchers recommend that state regulators work with physicians, consumers and other stakeholders to detail how to best use the information.
“Providers have important and genuine concerns about the appropriate use and interpretation of the data, and a blueprint could guide the actions of potential end users regarding what measures are appropriate to hold individual physicians accountable for, and how the data should be analyzed and displayed,” Damberg said.
Nearly all stakeholders who were interviewed for the study, including physicians, saw benefits associated with collecting and using the information. The report highlights key issues and questions that need to be addressed as state regulators consider how best to include physician information in hospital discharge data.
Support for the study was provided by the California HealthCare Foundation. The report, “Exploring the Addition of Physicians Identifiers to the California Hospital Discharge Data Set,” can be found at www.rand.org. Other authors of the report are Sandra H. Berry and Nicole Schmidt.
The California HealthCare Foundation works as a catalyst to fulfill the promise of better health care for all Californians. It supports ideas and innovations that improve quality, increase efficiency, and lower the costs of care. More information is available at www.chcf.org.
RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.