Bill Summary: HB10-1330, the All-Payer Database: A Transparency Trojan Horse
By Linda Gorman
What the Bill Does: Gives the Executive Director of Health Care Policy and Financing the power to create a database to collect and store unlimited information on everyone who provides or receives health care in Colorado whether or not the state pays for that health care and whether or not the transaction is a private one.
Appoints a Commission to advise on metrics to be used in the database. The bill states that the metrics will measure such things as #39;safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness,#39; #39;utilization, health outcomes, and cost,#39; for #39;consumers, payers, and purchasers.#39;
The bill requires the Executive Director of Health Care Policy and Financing to appoint an Administrator to create the database. The bill creates the database no matter what the Commission does. The Executive Director can make health care data reporting mandatory. The Executive Director will have the authority to require any data source to submit the data he might require, may conduct audits, and may give the data to third parties without anyone else#39;s permission. The Executive Director may impose unlimited fines if an entity refuses to comply. The Executive Director does not have to produce public reports.
The Administrator is to fund the database with gifts and grants from unknown groups with unknown agendas and no particular interest in the welfare of Colorado residents.
How the Bill Endangers Colorado Citizens:
1. Because it enables the creation of dossiers on citizens, the bill transfers too much power to state government — Passing the bill automatically authorizes the creation of a database potentially containing detailed individual information on everyone in the state. The bill does not allow entities to opt out of the database. There is no restriction on the information that can be collected. The state can share individual data in any way it deems appropriate. The state can demand detailed data from an individual#39;s medical or insurer records (the bill calls them provider and payer records). Those data may include information on physical functioning, medical treatment, mental stability, addictions, adherence to government health recommendations, family structure, sexual habits, and financial arrangements. Unlimited fines may be levied on those who refuse to comply. Private businesses may be required to disclose proprietary information without compensation. The bill does not limit the state#39;s ability to use the data to coerce the behavior of private entities.
2. The metrics discussed in the bill do not exist. The use of poor substitutes will likely increase health care costs and degrade health care outcomes. Existing health care quality measures measure process, not outcomes. Outcomes are poorly measured because risk from comorbidities and individual genetics are not well understood. Publicly reported quality process measures for heart attack treatment explain just 6 percent of hospital-level variation in 30-day survival. Improved compliance with process measures at community health centers is not associated with improved outcomes. In New York, mortality report cards encouraged physicians to improve their rankings by refusing to treat the sickest people. Excessive attention to process compliance discourages innovation. It encourages discrimination against people who fail to comply with recommended #39;health improvement#39; plans. People in socioeconomic circumstances making compliance difficult are victimized.
3. The bill funds the database with money from undisclosed sources with undisclosed agendas that may not be in the best interests of Colorado citizens. The bill encourages the Colorado legislature to shirk its duty to examine the costs and benefits of measures that affect the people of Colorado. Because the database is privately funded and created regardless of the study Commission#39;s conclusions, the General Assembly is refusing to even examine whether such a database makes legal and economic sense. It also fails to come to grips with the question of whether Colorado citizens using their own money to buy and sell services should be forced to provide information on those transactions to the state. The bill#39;s fiscal note is misleading. It says that the development and operation of the database incurs no cost to taxpayers. At minimum, taxpayers will pay for the time that several high ranking state officials will spend on the study Commission. It also says that the bill will cause a #39;potential increase in all funding sources#39; in 2011-2012. Unless the funding secured funds the database in perpetuity, maintaining it will cost substantial amounts. Whether maintenance is funded by higher taxes, escalating fines, or taxes disguised as fees is immaterial–the citizens of Colorado will end up paying for it.
4. There is no known way to secure the private information that the state proposes to collect. Electronic databases that make data widely available are inherently insecure. Records containing detailed information on individuals make it possible to accurately guess identities without unique identifiers. The Census Bureau uses disclosure avoidance techniques on publicly released Census data, but this introduces significant errors in the conclusions drawn from it.
5. There is no guarantee that the Commission appointed to study the database issues will have the expertise needed to accurately ascertain its consequences. Evaluating metrics to measure cost, performance, and quality requires specific expertise in statistics. None of the members of the Commission are required to be expert in health statistics, health data, econometrics, or statistics. There is no requirement that information technology experts in database management and security be appointed to the Commission. There is no requirement that any member of the Commission be expert on the ownership of patient records, or on the Constitutional takings problems inherent in requiring doctors, hospitals, insurance companies, and other health care providers to report proprietary data. There is no requirement that members of the Commission have sufficient depth to judge the medical appropriateness of a particular metric in various medical specialties.
Linda Gorman is the Director of the Independence Institute#39;s Health Care Policy Center.