Mining our own business

A doctor’s office is a private place. Patients would never assume their treatment and conditions are being used in sophisticated drug company marketing schemes targeted at their doctor. But that’s what is happening.
Without physicians’ consent, private companies make millions of dollars buying and selling information about which drugs doctors prescribe for their patients. What many patients and doctors think is confidential information protected by law, is actually for sale to pharmaceutical companies. Those companies then use it to influence prescribing choices made by physicians through aggressive direct marketing.
A bill before Maine’s Legislature will halt this invasive and highly lucrative process known as “data mining” while preserving use of the information to track safety, carry out public health studies, monitor Medicaid spending and other public purposes.
LD 838, An Act Protecting the Confidentiality of Prescription Information, will ensure the highest levels of privacy and care by forbidding the sale of doctors’ prescribing information to private companies for use in pharmaceutical marketing.
{The people of Maine found out that their identifiable prescription data is being data mined and sold to drug companies and want to ban this practice by law. What they do not realize is that marketing to doctors is not the only unwanted and illegal use of their personal prescription records. Identifiable prescription records have been data mined daily for over a decade and sold to insurers for underwriting and to large employers who want to know what medications their employees take. These secret uses result in discrimination, job loss, and increased insurance rates or even insurance denial. Losing your job or not getting one in the first place is even worse for you than having drug company representatives pressure your doctor to prescribe a different medicine. ~ Dr. Deborah Peel, Patient Privacy Rights}

To Find a Doctor, Mine the Data

Now that millions of consumers are surfing the Web to research their own medical symptoms, many are taking the next step: comparison-shopping online for hospitals and doctors.
When Kirk Emerich, a bank executive in West Bend, Wis., needed knee surgery for a volleyball injury earlier this year, for example, he researched the local doctors and hospitals, using a Web site provided by his employer’s insurer, Humana. The comparative data included the number of patients that the hospitals treated annually and the complication rates after surgery.
“Both our hospitals were pretty good,” said Mr. Emerich, a senior vice president for West Bend Savings Bank. “But the doctor I ended up with had an edge: she was more focused on sports injuries.”
As their out-of-pocket health care expenses continue to grow – through rising medical costs, higher insurance premiums and heftier co-payments – many people are using consumer skills well honed by online research on everything from digital cameras to S.U.V.’s. And their employers and insurers, intent on getting the best value from their own health spending, are arming those consumers with increasingly detailed searchable databases.
The data come from medical records that insurers are pressing doctors and hospitals to provide, and in some cases from patient surveys.
“We believe American consumers should know as much about the medical care they receive as they do about the vehicles they purchase,” said Sharon Baldwin, a spokeswoman for General Motors, the nation’s largest private purchaser of health care. Next month, G.M. plans to brief its salaried employees about their health benefit options for 2006, and will provide online information to help them make choices.
So far, the various consumer databases, many available only to individuals enrolled in insurance plans, have some gaps.
“We’ve got terrific measurements information in some areas, but in other areas we don’t have good measurements at all,” said Dr. Carolyn Clancy, director of the federal Agency for Healthcare Research and Quality, which is working to standardize the way health care data are reported.
At this point, there is much more quality-of-care information available about hospitals than about individual doctors, except in nine states including Florida, Pennsylvania and Wisconsin that make statistics available on the numbers of procedures that surgeons perform.
And pricing information still tends to be scarce. But the databases can grow only more robust, now that the full weight of the health insurance industry is behind the trend and the federal government is beginning to wield its influence.
Anyone, insured or not, can now log on to the federal Department of Health and Human Services’ Web site called Hospital Compare (hospitalcompare.hhs.gov), which uses Medicare and Medicaid data to assess the track records of more than 4,000 hospitals around the country.
Want to know which hospitals in your city to go to for treating heart attacks or pneumonia? Log on to Hospital Compare, plug in the step-by-step particulars, and judge for yourself, based on criteria that include whether the hospitals provide appropriate medicines when patients are admitted and discharged.
The government also plans to begin reporting on complications after surgery and whether doctors and nurses make clear to patients how to take care of themselves after a hospital stay, said Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid.
Private health plans typically provide more comparative data than the federal Web site. Yesterday, Wellpoint, the nation’s largest commercial health insurer, announced that its 28 million members would be able to log on to an expanded list of health care information services. The service is to include software to help members compare their own potential costs under various health plans. Wellpoint began providing consumer information for comparing hospitals several years ago.
Vivian Johnson is a Wellpoint enrollee who works for the Banta Corporation, a national printing company. When she transferred to Lancaster, Pa., from Utah earlier this year, Ms. Johnson used a Wellpoint system to research doctors for herself and pediatricians for her 2-year-old daughter, Averie.
“I relied heavily on certain statistics,” Ms. Johnson said, like “how many patients the doctors treated, where they were located and in some cases feedback from consumers.”
Besides Wellpoint and Humana, most of the big insurance companies – including United Healthcare, Aetna and Cigna, as well as many state and regional Blue Cross and Blue Shield insurers – provide this type of information. One of the most recent to join the wave was Michigan Blue Cross and Blue Shield, which on Sept. 1 started offering online hospital and doctor comparisons to its 4.7 million members.
“The insurance carriers are all headed in this direction,” said Dale Whitney, corporate health and welfare manager for United Parcel Service, which offers plans from all the big national health insurers to its 328,000 employees across the country. “A lot of employers are trying to get people to say, ‘Yes, I have some responsibility to take care of my health.’ “
The raw material for the information on the Web systems is typically assembled from data that include medical payment claims, hospitals’ reports to Medicare and health care information from employers who belong to an alliance known as the Leapfrog Group.
Companies that collect and organize the information include Subimo, a privately held company that supplies data for Wellpoint and Michigan Blue Cross, among other insurers; HealthShare Technology, which was recently acquired by WebMD; and Health Grades, based in Golden, Colo.
In May, Wellpoint bought Lumenos, a data compiler. And last year, UnitedHealth Group bought Definity Health, a company that, like Lumenos, operates high-deductible health savings plans and provides comparative data for consumers.
The ability to compare costs is especially important for a growing number of employers seeking to interest their workers in high-deductible health savings plans that offer lower premiums at the onset but require plan members to assume more of the financial burden when they need care.
The Detroit auto companies, which spend billions of dollars annually on employee health benefits, are among the large employers considering making such plans an option. DaimlerChrysler said last week that it would offer a high-deductible plan along with online information about the quality and costs of certain doctors.
Specialists say that, so far, the sources of information are far from perfect. Data based on medical claims payments can be particularly sketchy and unreliable, said R. Heather Palmer, a professor of health policy and management at the Harvard School of Public Health. “The hope,” she said, “is that as we move toward electronic medical records, we will get data with more clinical detail.”
The data collecting companies make no claim of perfection. “In the absence of perfect information, we help equip people so they know what questions to ask to be smarter consumers of health care,” said Ann Mond Johnson, chief executive of Subimo, a five-year-old company based in Chicago.
Most specialists agree that improvements depend on achieving a standardized, computerized approach to collecting and assembling medical data at all levels, from big hospitals to small doctors’ offices – a long-range goal of the Bush administration.
Until information technology is more widely available, “it is extremely difficult to collect this information, and it is expensive,” said Charles N. Kahn III, president of the Federation of American Hospitals, a trade group of for-profit hospitals.
But others say that, technology questions aside, medical care providers need to be more forthcoming with information.
“For the last 15 years, the hospital industry has resisted public reporting,” said Dr. Mark D. Smith, president of the California Health Care Foundation, a nonprofit research organization. Doctors and hospitals are still reluctant, he said, “but they are increasingly comfortable with the inevitability and desirability of public reporting on performance.” He added, “It’s a huge improvement.”
The foundation has a Web site (calhospitals.org), which uses patient survey data to enable anyone to compare California hospitals within a county or metropolitan region on a wide range of performance criteria.
Margaret O’Kane, president of the National Committee for Quality Assurance, which certifies health plans, said the hospitals had a lot to answer for. “There are huge issues out there in the number of people being harmed by hospitals,” she said, referring to statistics indicating that tens of thousands of hospital patients die each year from avoidable medical errors.
Publishing more quality data can help change that. “No hospital wants to have data out there that makes them look like poor performers,” she said.
Mr. Kahn, of the hospitals federation, acknowledged that “consumer education is part of the future.” But, he added, “we are only at the beginning of knowing what information to collect to get a meaningful reflection of the quality of specific institutions.”
Even so, Mr. Emerich, who found his knee surgeon online, says the information already available is helpful. His operation turned out well. “I’m fully active, with no restrictions,” he said. But, he conceded, at age 42 it might be time to think about giving up volleyball.