I think this will move it forward. If youre a patient, you care about your metric. Its wonderful were monitoring if doctors give quit smoking advice to patients. Im not a smoker so it doesnt matter to me. What you want to know is i know somebody whos about to have heart valve surgery. They want to know which doctor in their city performs the most heart valve cities and how many patients are alive a year after that. The fact we cannot answer that for that patient today or tomorrow or even next year, like, thats the question we want to answer. Its not like, do your diabetics have their a1c under control . Im not a diabetic, but if im diabetic and its under control for me, i dont care if your other patients are, i care about me. Were a me culture but we have to make sure the data releases can be customizable so the person interested in their own health and their own situation can get some answers from it. Charlie, at the same time, patients are complaining all the time about high copays, deductibles. We spend billions of dollars a year in unnecessary care or marginally useful care. And this conversation and this data release gets us closer or gets us away from spending all of those extra dollars that we dont need to spend. No question. So i think it does come back to haunt the individual patient. If your copay is going up, your deductible, the cost of your insurance is going up. The reason is, were spending too much money. How can we provide highquality care. We have to factor in koos long with outcomes. We have a question here. Tell us your name, where youre from and your question briefly. Yeah. My name is bea young, i live in maryland. First, i congratulate you, transparency of data system is great, but i wonder how far can you go, how do you deal with you didnt get data from internal system because the nurse did not give it to you or you did not even maintain the system the information you receive from patients. Its very critical, very important. Currently today theres a letter about who are the physician in which hospital in which area, the checkbook or reference you or government agency, theres nowhere you can find it. A lot of they use false name [ inaudible ] so how do you catch the system, the real information that you should need, like from computer, consumers or patients. A lot of nurses dont even give patient treatment if they ask for it, the record. They dont give the record. If they do, they give it fraudulent record, fraudulent charges. That type of thing. Things are very critical, very essential. For you to compare a patients, physicians and real professional and fake. Because a lot of emergency staff, they ask why are patients give the liquid to the patient so they can perform the procedure. And if you ask any physician for proof, they say, no, they dont have it. Let me try to wrap this up so we can get go ahead. So, misdiagnosis as well as patients all the various reporting system and other procedure that i i got up. I got it. This touches thank you. This touches on a couple of things our other panelists might get into it, especially our last panelist. A lot of our work started with the physician data set. But as were hearing, there are so many streams, and you touched on this, wanting to know about the Referral Network as the net set of data that could be important to triangulate. Were talking about painting a better picture on the complexity of health care services. Do any of you have some comments on we mentioned hospital, we talked physicians, drugs or devices, other pieces of this puzzle which are much more complicated than what weve touched on. So her end point, when youre talking about Physician Services and Medicare Part b, thats a payment going out the door, sflit when youre talking about part d, prescriptions filled, at a pharmacy, they log a prescription being dispensed, maybe its not bes dispensed. Theyre being paid for it being dispensed. When you talk about a referral, there are two different claims that are made. When you talk about quality metri metrics, chuck, im sure can you get into this. The quality of electronic records, the quality of paper records leave so much to be desired, when youre trying to adjust for things like that, were a long, long way away. And thinking about different settings. Hospital, hospital, physician offices and then thinking about er settings, intermediate care settings. The complexity of all this can be so overwhelming it could cause you to say, why bother releasing anything because we cant do all of it . It seems like the first was the hospital data, which you talked about. And thinking about physician charges because of the florida case. Know weve also got new to me was the information around dialysis and some of these other services we do have data released on. Are there other transitional care or care settings we think we really need to have better transparency around that would be important for patients to have . Well, not to well, let me plug the commonwealth publication on this. For those who havent unsolicited. There are two things that need to be stressed. First, the physician data has to be integrated with the hospital data, with the pharmacy data, to look at any of this data in an isolated way, in a way it addresses some of what youre bringing up. To do it isolated doesnt give you the right picture. Have you to put it all together. And comparisons are really difficult, but as the commonwealth publication pointed out, until we get into real detail about outcomes and Health Status and demographics, well never really be able to make good comparisons or the perfect comparison. So, hopefully one day we can get there. And were moving in that direction right now. Im going to do a lightning round to ask very quickly, ten seconds, 15 seconds. What has what has been released to date . What have you learned from it . Something just to give our audience in the room as well as on the website something that may have surprised you about what has been released to date. Ill just go ahead and kick it off. I will say the thing that did surprise me is exactly what charlie touched on. This was actually mo to not my patients necessarily but hi more physician colleagues and Health Insurance plan colleagues kind of say, this is really exciting and interesting and wed really like to get into that. Something that surprised you or something you learned from this release process. So, im a geek. I like looking at patterns. In the physician data, just looking at how Different Services were concentrated or not concentrated in certain specialties. I think the other thing the thing that surprised me the most, actually, was how few cpt codes physicians built. If you had woken me up in the middle of the night before i started the project and said, how many cpt codes are physicians billing, the average primary care physician, i would have said easy, 50, 60 a year. Maybe more. For many for a significant chunk of physicians, they are billing 10, 15, sometimes even less. But theyre some of them are really cranking through the cpt codes but they are specialists. So, that was the Biggest Surprise to me. Perfect. I had grown up as a Health Reporter lerping about differences between hospital referral regions and how important hospital referral regions are. I think what i learned through here is just how much variation there is within those hospital referral regions and you can literally go one street over and the quality of doctors as measured by services they use, drugs they prescribe is so vastly different and it makes a difference to look up an individual doctor. Chuck . I looked up my data. I thought you were paying me more. I have to take a cut off the top. Thats nialls new job, gets a cut off the top. I have to compliment cms because i think you got it right in my case. But ive been doing this for more than 30 years. And it it was really hard for me, despite all of that experience to make any sense of it and i began to imagine, well, what are patients thinking . How do they figure out whats going on here . Thats a perfect segue for some of our future conversations. Join me in thanking our panel. And weve got let me do this. If i can ask our second panel to come to the stage. Im going to have Paul Ginsberg from usc schaeffer policy, who also has an extensive background and bichlt o, im not going to read, as well as a number of publicationings related to research in this area. Hes going to be leading our second panel. Let me make sure i dont get in everybodys way here also take off ill have paul oh, good. Paul didnt need to use the stairs. Paul, sit down and then well remike. Well see if we can swap out some glasses for you guys. Paul will be leading the discussion on implications and perspectives from researchers, policymakers and payers. We teed up a few of these in our first discussion, but i think well have a robust one with the second panel. Thank you. Thank you. I think we can start now. Really pleased to be moderating this panel. I think stu at the beginning of the conference set the tone about this is transparency. This has been a long time interest of mine. Ive always believed some of the confusion about transparency comes from the fact that we talk about transparency because of its aspect of sunshine. We believe Public Institutions but other institutions, their operations ought to be more transparent. We also talk about transparency in terms of it being useful to different types of entities. We think of patients, consumers. When we think a little further, we think about physicians, hospitals, health plans, researchers and policy makers. And this panel is really about what the three different audiences can do with this information. And we will given with jay white, a very distinguished researcher, talking about what this means for researchers. Then ill hear from lew sandy, an executive with the United Health group, talking about what this release can mean for health plans and lawyers who are their clients and some of them do it themselves. Then well hear from bruce with a long policy background to speak from the perspective of policymakers, what can they learn from this information that will help them in their work of making policy down the road. There are two contacts id like to ask the speakers to think about. One is that as we were going to talk concretely about the april data release that Niall Brennan was describing to us, but were not going to dwell so much on what was in the april release but also to talk about what could be in further re future releases and whereas niall couldnt talk about what will be in the next release, they can talk about what they want to see in the next releases to make it more useful. The other context is this is not these releases are not the only game in town. You know, with chapin as a researcher, he can go through the process of paying a lot of money and taking a lot of time to negotiate a data use agreement with cms and get some of the data thats really raw behind this release. Li lou with United Health care can either work with a qualified entity or apply to become one and also has another channel. This is also part of the context. Im going to stop my talking. Thank you, paul. Its really terrific to be speaking with you all today. And i think the first question i want to get into it whether this data release of the physician charge and payment data is a big deal. Again, im coming at this from the perspective of a research. We had a couple conversations at rand, salivating over this new data source. What can we use it for . What questions can we ask . We figured out, well, there isnt much new we could do with research. Any Research Questions we would want to get into the claims data that we do all the time. Does that mean this data release is not a big deal . Not at all. I think this data release is really important and is a step forward. Why is it important . Number one, i think the release of this data has laid down a marker. For decades as niall mentioned this, there was an injunction in place that prevented cms from reporting what individual physicians were being paid by medicare. By releasing this data, cms has said that balance between physicians right to privacy and the publics right to know whats going on in the Medicare Program, its now officially tipped in the direction of the publics right to know whats going on in the Medicare Program. The other thing thats important about cmss release of this data, theyve laid down a marker and said, we can release data for a specific physicians and cpt codes without running afoul of hip a. If you do research, hipa is a fast barrier reef that you have to learn to navr gate. And cms has charted a course others can follow it now. Thats the first important thing about this data release. The second thing is these data by themselves, arent informative or telling but data becomes useful when its put in combination with other data. As cms releases more data over time, well start to see trends. Now that we have the physician level data, we can confimbine i with the hospital level data for geographic regions and get a fuller picture of whats going on. As other data sources become available identifying physicians by npi or National Provider identifier, we can start combining this cms data release with those other npi level data. And conceivably at some point private Sector Health plans will begin releasing data if its released in a format compatible with the data cms is releasing, then you have a threedimensional picture of whats going on in the health care sector. The other last point i would make is that this data release is a small step but its a step in the direction of building our Data Infrastructure to understand where we are and whats going on in the world and to help us make better policy choices as a society. And i think one thing we forget is that our Data Infrastructure has been built through conscious, sustained effort. And concepts like Gross Domestic Product, we take that for granted. We track how its going up and down over time. Its grown by such and such percentage. The concept of Gross Domestic Product was defined and the tools formering it have been honed over decades and we devote significant resources to tracking that. Thats a tool for the use of businesses, government, individuals and so on. Its a collective Data Resource that has been built through effort. And i think that is an incredibly valuable effort. I think the cms data release is one piece in that valuable effort. In terms of where were going next, what i would be interested to see, the private sector is kind of the black box. Medicare is starting to lay all of its cards on the table. But in terms of prices, practice, patterns, geographic variation in the private sector, is more challenging to get a hoojdz that. And to the extent we can get private sector data releases that are structured in the same format as the cms medicare data releases, then we can start comparing prices, start comparing Practice Patterns, identifying geographic identification patterns in both of those sectors. That to me would be the most fruitful and probably also the most difficult avenue to go. Ill leave it at that. One question fof you. Probably better serves many of researchers needs. Any thoughts about how that process could be streamlined, could be made more efficient as ab an aspect of the transparen initiative . Well, the data could be made cheaper. We pay taxes for a reason. We pay taxes so the federal government can provide services that shouldnt have a high marginal price attached to them. Data is one of the thijs that should be made freely available even though it takes a lot of resources to produce that data. Once you make one copy of the medicare data claims file, so, the price could be made lower. The turnaround time could be reduced. Thats a significant problem. Hipa, thats just a fact of nature at this point. Have you to satisfy all the privacy constraints. But the turn around and the price, i think, are barriers to research that could be lowered. Thanks. Lou . Well, thanks. Thanks, paul. Appreciate the chance to be here. I appreciate stu and the Commonwealth Fund for sponsoring this. What i wanted to do is talk about what is useful in this release, what are some limitations and some of the suggestions, to your point, paul, about where do we go from here. First thing i do want to say, as i really want to commend cms for their efforts to promote transparency and the use of these data is refreshing. And its incredibly important. It will evolve this idea of evolution over time is an important theme of this event. You know, even in this current release, there is some utility in this information. Weve heard a little about this today already. I think its useful in raising awareness of variation. The pervasiveness of variation that we see out of the data. Useful in understanding the variations in that data. Useful frankly, its so obvious, doctor cutler mentioned this, useful in bringing transparency around what things cost. Just the basic information there. And i think claims data useful for some thing, not so useful for other things but it has useful dimensions around volume, around the service mix. Im not in practice anymore. Im a general internist but i looked up some of my friends to see what their practice pat ites looked like. Their practice would be heavily concentrated in a senior population. Its important, and it will provide useful insights in its current, limited form. Now, what are the issues and limitations . I think the most fundamental one is health plans have learned over the years that looking at raw claims data is really more an enter size in high hypothesis generation. You cant look at a raw data table and say, aha, theres an outlier, lets do something its really more a hypothesis you have to triangulate around, look at multiple data sources, look at trends over times. And then have a further exploration, particularly it may involve, this is something health plans do regularly, have a conversation with that physician to see you might find an outlier that statistically is an outlier, but they actually are referral practice and have a unique set of services they only theyre the only ones who provide that in a region. I think hypothesis generation is the way we should think of raw claims data. The second thing, as i said, a lot can be done with claims data, but it requires analysis. All of us wi