Hypothetical Mean

Commentary from an Actuarial and Economic Perspective

Health Care Data Cleaning becomes Big Business

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The WSJ blog details how Athenahealth is hoping to earn profits by helping doctors comply with arcane insurance company, Medicaid, and Medicare data processing requirements. They present this as entirely wasteful. It’s not. If, like all health policy wonks and politicians, you want analytically useful healthcare data, someone has to force data compliance at the point of service. This means burdening doctors. How else will you get data on disease management practices and effectiveness? Or to evaluate physician quality? (note: all insurance companies are being required to do this)

Clean data is incredibly expensive.

Since the movement for clean analytic data began, Medicare, Medicaid and insurance companies have built claim systems to make sure that submitted claims have sensible diagnostic and procedure codes associated with them. If the claims are unusual, they will generally deny in part or in total and, at a minimum, force a manual review process. This ensures a minimum standard of cleanliness in the data. This, in turn, forces doctors to increase their data sophistication.

Is all of this effort worth the cost? I have no idea; but we shouldn’t pretend that we aren’t buying something with all of this money spent on IT. You can’t simultaneously argue that this administration expenditure is worthless while at the same time demanding that people engage in ever-more-detailed disease management, wellness programs, or even purely academic analyses.


Written by Victor

September 28, 2007 at 3:31 am

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