After five years of preparation, the state of Texas made its first public disclosure of hospital discharge data late last month, belatedly jumping on a national bandwagon that began in the early 1990s. But it will be months longer still before the state's 20 million consumers will be able to use the information to make quality comparisons.
The Texas Health Care Information Council, an independent state agency, released a database of 1.2 million inpatient hospital discharges during the first six months of 1999. It also provided descriptive statistical reports on its Web site.
The initial release will allow hospitals and the state to track utilization trends, hospital industry officials said. But it falls short of the council's ultimate goal of providing hospital cost and quality data to consumers.
State law prohibits the council from using the database to generate a consumer-friendly report card with quality indicators, such as mortality and Caesarean-section rates, until a full year's worth of data is collected and analyzed, probably by early next summer. Copies of the database cost $1,000, or $500 for hospitals.
Consumers also will have to wait longer for cost data, which is being collected from hospitals starting with third-quarter 2000 data. The council, created in 1995 by the state Legislature, has released two HMO report cards.
Council Chairman Lewis Foxhall, M.D., associate vice president of health policy at the University of Texas M.D. Anderson Cancer Center, Houston, said collecting and processing hospital data have been complicated, especially because Texas is a large state with more than 400 institutions required to report.
He said the initial release proves that "a very complex process has been dealt with and is working."
Denise Remus, vice president of data initiative at the Dallas-Fort Worth Hospital Council, said the data will enhance a database operated by the federal Agency for Healthcare Research and Quality, which recently was charged with preparing a national assessment of healthcare quality. Twenty-six states contribute to the database, and Texas has been "a huge pocket" of missing data, she said.
The data follows the format of form UB-92, which is used to submit charges to third-party payers. The state requires hospitals to collect additional information, such as patient race and ethnicity. Exempt from reporting are stand-alone hospitals, those in counties with less than 35,000 people and hospitals that don't charge for services.
Remus said Texas is the first state to have physician identifiers. Starting with year 2000 data, patient identifiers also will be included, allowing researchers to track re-admissions and transfers, she said.
Despite the consumer-oriented intent of the Legislature, the hospital industry is expected to be the biggest user of the data, for both marketing and strategic planning as well as quality improvement.
Based on the mixed experiences of other states, it will be challenging to make the data useful for consumers, hospital industry officials said.
John Gavras, president of the Dallas-Fort Worth Hospital Council, said hospitals are nervous about how the data will be interpreted. For that reason, the council held a media briefing last week to explain the data to local reporters.
Nevertheless, Gavras said hospitals and physicians support the release because they had a say in how it would be handled.
"There's not going to be anything under the table," Gavras said. "The hospitals have said: If the data is timely, accurate and can be analyzed, then so be it."