A Philadelphia-based information management company has decided to offer its complete database of publicly available hospital clinical data free to the healthcare industry.
The company, Care Management Science Corp., said it's making Medicare and state-level information accessible to providers over the Internet. Company executives hope the move will focus healthcare on using clinical information to cut costs instead of fixating on increasing revenues-a fading strategy.
With Medicare reimbursements and other revenue sources flattening, and administrative cost-cutting measures nearly exhausted, the management of clinical decisions and resources represents a largely untapped opportunity to bring costs in line with available revenues, said David Brailer, M.D., chief executive officer of Care Management.
The company is trying to position itself as the instrument of choice for such clinical troubleshooting by increasing its name recognition and familiarizing providers with its method for discovering areas for improvement, he said.
By making Medicare and state patient data routinely accessible, Care Management is seeking to deflate the moneymaking potential of the data among competitors.
"Since this is public data, we don't think it should be sold for a lot of money. We think it should be free," Brailer said.
A small group of healthcare information management firms has mobilized to sort through the clinical complexity of hospitals for ways to deliver care more efficiently. Most of them use Medicare and state patient information, which typically is 1 to 2 years old, to produce custom reports costing thousands of dollars, Brailer said.
Care Management had charged $5,000 to $10,000 annually for access to the CaduCIS Net database and the software program that sorts the data. That access is now provided at no charge. The company is refunding the current year's fee to 350 customers, which amounts to a loss of at least $2 million, or more than 10% of annual revenues, Brailer said. "Our hope is that every other vendor will follow us and get these (public data) out in the market where they belong."
Such a scenario would force companies to differentiate themselves on the strength of their decision-support capabilities and ability to pull extensive clinical data from the information systems of hospital customers.
The Care Management offering includes an analytical framework, developed by the University of Pennsylvania's Wharton School of Business, that's designed to identify areas where providers can cut the costs of caring for patients.
The flagged areas must be further investigated to determine the causes of and solutions to problems. That requires capturing more detailed data than can be found in the billing codes mined for Medicare or state databases.
The additional detail, including tests and therapies employed by individual clinicians, can be supplied only through patient chart reviews or by contracting with a firm that can capture and crunch the information-such as Care Management.
If the free Web site's benefits persuaded 15 providers to move up to the company's customized clinical management service, the loss of fees from free access to the entry-level service would be covered, Brailer said. The custom service, called CaduCIS Manager, has 175 customers.
Care Management, which is headquartered on the Wharton campus in Philadelphia, was established in 1992 to bring the business school's clinical analysis formulas to market.
Key to the Wharton framework is a formula for assessing patient conditions at admission and predicting the impact of those conditions on a patient's chance of survival or deterioration in the hospital, Brailer said.
Providers can use more than the primary diagnosis, such as information revealed by a severity-adjustment formula, to separate conditions present at admission from conditions caused by clinicians' actions.
That requires accurately separating hospital complications from existing medical problems when scrutinizing secondary diagnoses and other clues in billing codes, Brailer said.
For example, a secondary diagnosis of congestive heart failure would make a physician's job more difficult if a patient had the condition when admitted. The patient's case would be severity-adjusted in the physician's favor. But if the condition arose after admission, that same secondary diagnosis would be a red flag that called for a closer look at what might have gone wrong.
The attention to complications is part of a sophisticated application of rules that CaduCIS uses to mine billing data for precise severity adjustment, Brailer said. He contends other methods use fewer data elements and are less likely to persuade physicians that unique circumstances are taken into account.
Any effort at clinical management has to neutralize the two biggest reasons physicians give for disregarding findings that suggest doing something differently, said Steve Landgarten, M.D., chief medical officer of 365-bed Hillcrest Medical Center in Tulsa, Okla.
The first one is that the data are unreliable, Landgarten said. The standard follow-up argument physicians use is that their patients are sicker than the norm, which explains why their track records aren't better.
If physicians are satisfied that the data are adjusted to account for secondary conditions and other factors, the chances of their accepting change improve, Landgarten said.
Availability of the data on the Web allows physicians to run queries and see for themselves if they agree with reports compiled by management
Though the publicly available version of the CaduCIS Manager is limited to defining clinical problems, it's a step in the right direction for providers, Landgarten said. "Knowing what questions to ask is certainly the beginning."