Improved quality of health care does not violate privacy

BY Linda Berglin

There appears to be some crucial information missing in the August 4 editorial on the new health care reform laws and how they apply to patient privacy. As the author of this legislation, I spent thousands of hours on taskforces, committees, working groups and commissions to come up with a package that would reduce unnecessary health care spending in Minnesota, increase access to health insurance for the working poor, small businesses and farmers, and improve the quality of health care services being offered. I have spoken with and heard from hundreds of constituents and citizens statewide on the issue of health care and believe that the health care reform laws begin to move us along a path that will lead to a lower cost-higher quality system.

Mr. Sullivan's editorial seems to imply that private patient data will now be available to governmental officials. Nothing could be further from the truth. The health care reform bill was based on efforts that are already occurring in Minnesota. The Minnesota Community Measurement (MNCM) is a nonprofit organization that has been collecting and publishing health care information on a wide variety of measures since 2004. Currently, over 700 clinics state wide participate voluntarily in providing this information. Published quality measurements at the medical group and clinic levels represent 90 percent of Minnesota patients. So, the legislation to bring the other 10 percent of patients into the mix is not new, revolutionary or intrusive. Information submitted by the group clinic, or health plan must strictly adhere to all federal and state data privacy laws. Medical files are never seen by the evaluating organization. It is truly irresponsible to suggest that any data collection will be done in violation of these laws.

In a number of focus groups conducted by MNCM, it was revealed that consumers DO want quality measurement information and actually expressed interest in having even more specific quality measures provided, such as outcomes for particular doctors.

It is also inaccurate to state that making quality measures available does not improve the quality of services provided. Since MNCM began publishing their measures, outcome measurements have improved. For example, in 2003, 71 percent of Minnesota clinics were using appropriate medications to treat people with asthma. In 2007, this number was 91 percent. Optimal diabetes care measured at only 4 percent in 2004, but increased to 10 percent in 2007. Proper chlamydia screenings for young women rose from 26 percent to 41 percent and childhood immunizations increased from 52 percent in 2006 to 74 percent last year. It is clear that consumers want to compare quality to make sure they are getting the best care possible and providers are improving over time when their quality scores are publicly compared.

There is also no evidence that patients are being denied access to care based on the complexity of their condition. The current variation in quality across clinics indicates that improvement across the system is needed. For example, optimal outcomes for diabetes patients range from 0 percent to 37 percent depending on the clinic. Proper care of asthma ranges 73 to 100 percent, appropriate breast cancer screening from 35 to 99 percent and proper blood pressure control from 45 to 85 percent. I know for a fact that a clinic with a 0% success rate in treating diabetes would not be my top choice and the ability for consumers to make that choice and provide information to clinics on their outcomes is one of the goals of our reform.

I live in Minneapolis. If my husband or I were to come down with pneumonia I'd rather go to the metro hospital that provides appropriate care 88 percent of the time than the one that only does so 45 percent of the time. Proper care for heart failure varies in the Twin Cities from 100 to 55 percent of the time. If you had this kind of information, where would you choose to go?

When the state makes the cost and quality information public, it must do so for all providers, not just the 90 percent who have volunteered so far. This is only fair. Until the state starts publishing this information in 2009, the results of clinic and medical group voluntary reporting can be found at: www.mnhealthcare.org/Report/Hospital quality information can be found and compared at:
www.mnhospitalquality.org