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Part II: Understanding All-Payer Claims Databases

Earlier this week, we discussed the benefits of all-payer claims database (“APCD”) systems. Nine states currently have APCDs in place, but Kentucky is not one of them. These systems provide a multitude of information on the cost, use, and quality of health care in a given state, but the question remains: how do providers feel about APCDs?

APCDs were developed before the enactment of the Affordable Care Act, but with the subsequent national focus on quality and cost containment, it is easy to see why these systems have gained tremendous popularity in recent years.

Still, providers should be aware of the information shared through APCDs. Every system is different, and states can largely tailor how the information gathered will be used and analyzed. What protections should be afforded to providers? In Maine, for example, there are specific restrictions on data which would reveal provider discount arrangements with payers.[1]

Questions to which providers should seek answers include: will the information gathered accurately reflect quality and pricing? Can the complexity of individual cases be relayed through the system’s coding? Will providers be able to protect their patients’ personal information, such as their age and condition? If APCD is made available to the public, what will be done to encrypt or eliminate such information?

Despite these concerns, providers may reap many of the benefits associated with APCDs. When an APCD is established, providers can rely on the system to assess expenditures and quality improvement efforts – a necessary undertaking for any health care entity, big or small. Providers can compare how different payers compensate for the same or similar services, compare their rates to other providers in the area, and assess the overall care that is afforded to their patients.

In short, APCDs offer great information, but providers should actively participate in any grass-roots movements or legislative efforts to implement a system. Providers should ensure that a system will work to their benefit, not their detriment.

[1] Robert Wood Johnson Foundation, “The Basics of All-Payer Claims Databases,” January 2014.

This article is intended as a summary of federal and state law and does not constitute legal advice.

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