APCD yeah you know me

The Senate just released a major bi-partisan proposal to tweak several significant health policy challenges. The headline proposal is eliminating surprise billing which occurs when a patient goes to an in-network provider and then gets an out of network bill for a specific set of services that they may or may not have consented to.

However, the data geek in me is hyper excited about Section 303. Here, the Senate is proposing a national all payers claims database (APCD).

‘‘(a) IN GENERAL.—The Secretary, in consultation with the Secretary of Health and Human Services, not later than 6 months after the date of enactment of the Lower Health Care Costs Act, shall have in effect a contract with a nonprofit entity to support the establishment
and maintenance of a database that receives and utilizes health care claims information and related information and issues reports that are available to the public and authorized users, and are submitted to the Department of Labor.

I am truly geeking out about the requirement that self-insured plans which are regulated by the 1974 Employee Retirement Income Security Act (ERISA) will be required to submit de-identified data. ERISA has a strong pre-emption of state laws for self-insured plans. The Supreme Court ruled in 2016 that ERISA pre-emption meant that states could not require self-insured plans to send data to state based APCD. Self-insured plans make up the overwhelming majority of large employer groups so missing this data means any database is wildly and non-randomly incomplete which limits the research value of these databases.

From a policy side, the argument for an exhaustive and near complete APCD is that it will compress price variation and allow for better/smarter negotiations and explicit trade-offs in designing benefits and networks. That should be cost saving. It will also allow for far better research that has far more generalizability with fewer caveats.

This is a big deal if signed into law and it should start providing good insight in a few years if it is enacted. I know I have at least one 2020 research idea where a complete APCD would be absolutely wonderful as the self-insured universe faces a different set of rules and incentives than the ACA universe for a particular problem I want to poke at. I know other researchers have similar projects in their want to do list too.






14 replies
  1. 1
    Gelfling 545 says:

    Sorry. Trump can’t be doing any signing or other presidenting right now. He’s upset.

  2. 2
    Leto says:

    Boooo to the post title! /slowclapofappreciation 😀

  3. 3
    Yutsano says:

    @Leto: Sshhh…it’s brilliant.

    That does seem to be this odd gaping hole. I know ACA did a lot but I wonder why this wouldn’t have been addressed. Especially since information like this could potentially affect ACA rates.

  4. 4
    Anonymous At Work says:

    1. Any poison pills in the bill?
    2. What will the HIPAA fanatics/privacy fundamentalists have to say about their data going to a central office for research and price control efforts? Diffuse benefits vs. concreted antagonism…

  5. 5
    Kent says:

    What are the chances that an actual ACA cleanup bill gets through Senate without getting larded down with other provisions designed to make things worse? How long is it going to take until Ted Cruz attaches some sort of abortion rider or anti-LGBT rider to this?

  6. 6

    Thanks as always for keeping us posted on this stuff!

  7. 7
    Betty says:

    I agree on the ACPD. Long overdue.

  8. 8
    Luthe says:

    Will this be for claims as submitted or claims as paid? And how will it handle potential double-billing?

    (My mom works as a biller/coder and I hear all about how long claims take to be paid because of rejections, resubmittals, etc. as well as system errors that double bill for the same claim)

  9. 9
    David Anderson says:

    @Kent: it is not an ACA bill.

    Pretty good chance it goes through the Senate in a mostly recognizable shape

  10. 10
    TomatoQueen says:

    Why is this being done now? Is it a shiny object to distract? I see it’s bi-partisan, and am deeply suspicious, esp as it sounds like two good ideas, one for the customers, the other for the kids in the back room, are appearing in the same bill. How the hell did that happen?

  11. 11
    jimmiraybob says:

    “She treats me like I’m either her maid…”

    More like Trump’s maid. Or is there a fancier title for chief flung-shit cleaner upper?

  12. 12

    @TomatoQueen: As long as Congress is staying away from the individual market AND/OR Medicaid, they’ve been willing and able to do some fairly significant health policy since March 23, 2010.

    This bill will reduce a lot of fear for middle and upper middle class families that think they have pretty decent insurance but have heard/experienced horror stories of getting a $30,000 out of network charge from an in-network hospital. That population votes and donates.

    APCD is a key enabler of any legitimate chance of making markets work in a manner that is not completely fucked up. It also has bipartisan wonk support. It will get some pushback from hospitals and provider groups that are making bank on an information asymmetry but I don’t think they can kill it.

  13. 13
    Anonymous At Work says:

    @David Anderson: Does “making @David Anderson: markets create an incentive for someone with extreme opinions (cough Sanders cough) to sabotage things to “heighten the differences”?
    I write this as someone whose closest hospitals employ maybe the nurses and cleaning staff only…everyone else is out-of-network…on purpose…

  14. 14

    […] Tomato Queen asked a good question in comments yesterday on my post about a proposed national all payer claims database: […]

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