The demand for physician practice data is now a political issue.
Wisconsin this year became the first state to require physicians to turn over medical-quality and financial data to a government agency -- something it and 37 other states already require hospitals to do. A new state authority that's taking shape will carry out the law.
Indiana, which also collects hospital data, may well consider a law similar to Wisconsin's in its 1999 legislative session, even though one disclosure effort failed this year.
Healthcare purchasing groups like California's Pacific Business Group on Health, insurers such as PacifiCare Health Systems and other private concerns have collected -- or are starting to gather -- such data. Brown & Toland Medical Group in San Francisco, which comprises 1,200 physicians, is now providing it (see related story on page 8). Generally, organizations seek data on cost and quality of services in hopes of finding the best and most efficient doctors.
But why go to the Legislature? "We're frustrated," says Jeff Goodwin, executive vice president of the Indiana Manufacturers Association, which recently premiered its own group purchasing coalition.
The 1,800-member organization tends to fight government regulation. But Goodwin says it's interested in legislation in this case because physicians -- due to lack of technology or will -- can't provide the cost and quality data it's looking for.
"We've never put it in our healthcare policy statement that a (state) board has to be put together" to collect physician data, Goodwin says. "I think for the first time going into this year, we thought in a broad context of what (data) legislation should be. If it's done properly, it will lower (healthcare) costs."
And there's the rub, say state medical associations fighting efforts to legislate data collection. Proponents of these bills don't want to find out which physicians are the best; they want to know which are the cheapest.
"Quality doesn't enter into what they're going to collect," says Mike Kirby, vice president of professional and public affairs for the State Medical Society of Wisconsin. "I don't think the Legislature understood what it was doing. It was one of those things that really sounded good."
The American Medical Association says it's tracking other states, but there's no indication of an imminent explosion of physician practice data legislation.
For one thing, collecting the data is expensive. The failed Indiana proposal listed the cost to the state at $45 million, not including the amount of technology and time required for doctors, says Jim Zieba, director of governmental affairs at the Indiana State Medical Association. Also, sending medical records to a state agency raises questions of patient confidentiality.
Despite those concerns, Wisconsin passed a bill that created an 11-member Board of Health Care Information to collect quality and financial data from physician practices and health plans. The board will have two physician members. Gov. Tommy Thompson is supposed to appoint the board members, but he has not selected them yet. The legislation does not specify which data should be collected; that will be left up to the board. The cost of gathering the data hasn't been calculated.
The data collection bill survived a long, hard road. In Wisconsin, a controversial bill can be sent to a legislative council that includes interest groups and private citizens so a consensus can be reached before it proceeds. The bill sat in a council in 1996 and 1997.
Rep. Gregg Underheim, a Wisconsin Republican, says the medical society made it clear during that time it would not support a physician practice data bill. The two physicians in the Wisconsin Legislature also spoke out against it.
Normally, that lack of unanimity would have killed the bill. But, Underheim says, "this one moved forward because the coalition of people pushing it was incredibly diverse and powerful."
Allies represented the state's major business, labor, teaching and hospital organizations -- disparate interests that rarely agree on bills. The business and hospital associations lobbied the Republican-controlled Assembly (equivalent to the House) while the teachers and labor handled the Democrat-controlled Senate.
With the exception of the American Civil Liberties Union, which worried about patient confidentiality in turning over records to the state, "the rest of the world was lined up against us," the medical society's Kirby says.
Even so, Underheim says, the bill got more debate than any other introduced in the 1997-98 session. After it passed the Senate 24-8, one physician legislator, Democratic Rep. Sheldon Wasserman, M.D., a Milwaukee obstetrician, introduced an amendment to prevent data collection. The Assembly passed the amendment, but when the Senate voted 20-11 not to concur, the Assembly rescinded its position in a 63-32 vote.
Underheim contends the medical society's position caused it to lose some allies in the Legislature and among other lobbyists.
"A strong perception developed that the interest of the state medical society was in protecting doctors' income and autonomy and anonymity," Underheim says. "Their interest was not in the well-being of the patient."
In Indiana, the state's Chamber of Commerce late in the 1998 legislative session pushed a data collection amendment to a patient rights bill, but no legislator ever introduced it.
Over the summer, two Republican legislators -- including Rep. Tim Brown, M.D., an Indiana State Medical Association member and the state's lone physician legislator -- led talks between business groups and the state medical association to see if there was a way to get data without legislation.
Brown says talks have broken down, in part because interest groups are waiting to see if the Indiana House's 50-50 party split will break up in the 1998 elections. The Senate is Republican-controlled. The part-time Legislature's 1999 session starts in January.
"There may be a bill no matter who is in charge," says Brown, who says he won't introduce legislation. "Some of the thought is, with Internet access and the information age, when you can find things out down to how the bolts on your car are made, you certainly want some sort of information when you're going to have bypass surgery."