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Knocking the Palooza Out of the Data

by Jonathan Bush, President & CEO

Just back from the Health Datapalooza confab that took place last week—an event now in its 4th year hosted by the federal government. I had a few lingering thoughts to share. First, on the event name: I’m guessing it came out of my old business partner and current national CTO Todd Park’s experience in Washington, where trying to get any single distinct thought through “the interests” could knock the “palooza” out of a grown stallion.

You’d think the federal government would be the last ones to host a Datapalooza, but the fact is NO ONE ELSE has stepped up!

So they did.

And complain as I might about the G-men and G-women being industry conference conveners (makes me want to bathe with a wire brush) they pulled it off pretty darn well. The Department of Health & Human Services (HHS) attracted hundreds of serious entrepreneurs… and hundreds more wannabes (who real entrepreneurs desperately need in order to feel cool).

And boy were there some great bloopers…

Kaiser came blistering onto the scene with an open API—to the location and hours of operation of its facilities! Kinda sounds like Yelp to me…I’d be surprised if developers will come a runnin’ to that one. Kaiser’s CIO (a very cool guy whom they or anyone in health care would be lucky to get) broke this news in a two-minute keynote speech. Imagine President Obama announcing, in a State of the Union address, that the green vegetables in the White House cafeteria were now much crunchier!

HHS Secretary Kathleen Sebelius applied similarly excessive fanfare announcing the release of cost data for 30 ambulatory procedures. The whole idea that Toddy (Park) was trying to get going with this Palooza was not to release REPORTS on things but to release the SOURCE data so that anyone with proper security and privacy clearance could INVENT a million reports that no one had ever conceived before!

So here are my thoughts on all of this, some of which I shared at the conference in my way-longer-than-two-minute keynote:

1. Release the data!! Secretary Sebelius announcing the release of cost data for 30 ambulatory procedures during her keynote felt like the Secretary of Energy serving up a can of 10W30 to oil companies to drill into.

Her words were great. To wit: “The fact that this [unlocking the data] is growing by leaps and bounds is a good indication that we can leapfrog over years and decades of inaction into an exciting new future.” YES! GO GIRRRL! OK, so…where’s the data?

Wait, you can’t mean the 30 procedures! That’s a report; one possible report, out of the millions that will be run and discarded once the underlying data is available. Data on 30 procedures? That is nearly NOTHING. In a stroke of good fortune, just a few days before the “Federalpalooza” the original 1979 court case, that has been the government’s primary reason for refusing to give paid claims data to HIPAA-covered, secure entities was overturned! NO MORE EXCUSES. The government is NOT supposed to play the game. They are supposed to make the rules and pinch the cheaters.

2. Let non-foxes apply to guard the henhouse. Right now only entities that are governed by at least 75% health care providers are allowed to apply to be an Accountable Care Organization—(ACO)…and most of THEM are mostly controlled by hospitals. Any analysis of where we are overspending in health care shows that the long pole in the cost tent is the hospital. We have 45% more hospital capacity than we should. No hospital wants an ACO bonus that comes out of its own revenue! It’s just self-preservation.

Now there is some nuance: Cheaper and smaller hospitals that are close to full and can steal share from bigger systems, could profit. But the point is the kind of skill you’d need to run a good negotiation, process control/coordination, information management and so forth are NOT found in ANY hospitals!!

Uncle Sam needs a provision in the ACO law for an Independent Risk Management (IRM) company, which would allow non-caregiver entities who are capable of managing “risk” related data to do so. We’ve been walking our proposal to make this happen around DC for months, and everyone we talk to loves it and agrees that empowering docs, not huge institutions, is the way to achieve real savings—but nobody with the power to change policy wants to stick his or her neck out to help make it happen. Don’t do it for me, do it for the nation!

3. Allow free market for health information exchange! Even once Uncle Sam releases the paid claims data, we won’t be close to where we need to be…because claims data is kinda lame! It’s been “coded” with payment in mind. What would be VERY cool is to get referrals and results/feedback between caregivers into electronic form. It would eliminate the ABSURD amounts of “re-work” we do today both as caregivers and as patients.

Ever get a clipboard from a practice that should already know everything they are asking you? The way this works in every other sector is through “supply chain partnership.” Whoever needs information pays whoever has it, once it’s delivered electronically. This way the receiver can change their mind and can ensure proper delivery because the sender gets a benefit for paying attention and connecting effectively. But because of old anti-kickback laws, this is ILLEGAL in health care…and ONLY in healthcare.

It would not be that big a fix. Just let payments of less than $10 be excluded from coverage under the Stark Law. What you are getting instead of this today is hospitals “employing” doctors in order to coordinate and kick back to them. They employ the doctor for $200,000 (give or take) more than they make, they put them on the same computer system as the hospital, and they make it clear that this old system is to be used to pump referrals towards the core. Referrals would be better coordinated and kickback levels would be lower if this game was given a breath of fresh air and everyone came out of the closet.

Yes, I rant about government. I feel violated when they step into the market. But when I am honest with myself, I know that they are supposed to step in when a market is broken. That’s their role. Sooo, we must un-break the market in healthcare…then Uncle Sam will have no excuse but to back out.

This article previously appeared in The Health Care Blog.

To learn more about Jonathan, read his bio or follow him on Twitter at @Jonathan_Bush.

Jonathan Bush is the President and CEO of athenahealth.

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