Jenci Spradlin

As a Tennessee resident with a chronic medical condition, I welcome the opportunity to know the costs of healthcare procedures throughout the state, as well as factual based information on whether a particular medical provider is actually performing his specialty well or not. I also welcome the ability of policymakers in the state to evaluate outcome data of healthcare programs to determine if the money being spent by the state is actually achieving the desired outcome.  These are the primary objectives of HB 2289, known as the "All Payer Claims Database."  In the name of consumer protection, we have required food manufacturers to list nutritional information on all packaging, and have advocated for caloric information to be placed on menu items in restaurants.  We seek out websites to comparison shop for everything from electronics to housewares.  Why should one of our most costly expenses, healthcare, be any different?

If such healthcare cost information was currently available, it would greatly help me as a healthcare consumer to determine the best and most affordable location to receive treatment.  Why? My neurologist ordered an MRI on my brain (I have epilepsy); the cost to have it done at his office is roughly $3,000.  I cannot afford this. Period. Who indeed has an extra $3,000 on hand to spend on something like this? Anyone? Anyone?  Aditionally, because West TN Healthcare manages/oversees a majority of the physicians in this county, there is no consumer choice to have a procedure like this done.  I called Blue Cross/Blue Shield to find out how I might find out the prices of MRIs throughout the state who accepted my insurance.  They could not do this for me, but told me that I could call EVERY provider of MRIs in the state and make the determination on my own.  What consumer is going to take the time to do this? Having a database that will show costs for medical procedures would solve this problem, would it not?  Indeed, also knowing what neurologists in the state receive the best outcomes for patients who suffer from epilepsy would also allow me to spend my healthcare dollars in the most effective way.  Many people today have Health Savings Accounts with high deductibles, meaning that they are responsible for 100% of their medical care costs up to the deductible amount (which in my case is $5,000).  Should I be forced to only seek care within my community, where I have no choice of MRI providers as well as neurologists? Wouldn't competition be a GOOD THING? Wouldn't that also reveal providers who take advantage of their location to jack up prices for the consumer? I found an MRI provider in Wisconsin who offers flat rate MRIs, regardless of insurance, for $600.  They publish this price on their website, and as such, physicians can help steer their patients to this very affordable option (and because of increased volume, they can offer this test at a very affordable rate.)  Question, would you rather be out of pocket $3,000 or $600? Do I even need to ask this question?

I spent over 30 minutes watching the discussion online in the TN Government Oversight Committee on HB2289.  At first, I was biased against this bill because of an email I received asking me to help defeat it.  I also read a thoughtful post by Ken Marrero offering his reasons why he thinks this is a bad piece of legislation.  Ken sees this bill as giving government access to our private healthcare information, but after watching the committee discussion, I believe his assessment amounts to "much ado about nothing."

The first thing I found interesting when listening to the discussion on this bill is that there is already legislation in TN regarding hospitals and their reporting to the TN Hospital Association that essentially includes much of what this bill desires to monitor.  That information hospitals send to TN Hospital Assn INCLUDES personally identifiable information, and has for a long long time.  Where is the outrage or desire to change that? (There isn't any.)

Secondly, our state spends billions of dollars on healthcare programs and treatment, yet we have no real means to find out if those programs are working.  How might we go about collecting health outcome data as well as healthcare cost information without obtaining information like this? I am all for looking at how we spend our tax dollars and saying, "Is it working?"  If we're not willing or able to do this, then I say, "Stop funding these programs NOW!"

Third, the information this database will collect, and that any third-party provider as part of this program will collect, does not in any way include any personally identifiable information to begin with.  All that information is, by design of the system, not included in what the insurance companies submit.  The TN system won't take it.  It won't be part of the information collected period.  Have you ever run a report from Excel on only SOME of the information you had stored in a spreadsheet? When you run that report, does data not associated with your report somehow make it into the report at all? Is it connected to the report? Can I get that information without rerunning the report? The answer is no.  So not only will the insurance agencies NOT be including that data, but it will be encrypted twice before it ever makes it to the state for analysis. 

I hope this bill will not be crippled due to partisan posturing; that would be a shame in my opinion. After watching the discussion within this committee, I also believe that many of those opposed to this bill simply do not have an understanding of technology, and are merely acting out of fear.  Perhaps they see this as an "accident waiting to happen" so they want to vote against it and claim that they are "looking out for their constituents." 

Just for the sake of argument, if these same legislators were discussing an electronic technology that would allow banks to issue cards to consumers by which they could make purchases at retailers across the state, as well as to obtain cash from these "mini banks" no matter where they are and even after banking hours, do you think that piece of legislation would ever see the light of day from this committee? "You mean to tell me that my constituent’s banking account information is going to be transmitted electronically?"  "So what you are telling me, is that if this system were compromised, someone would have access to my constituent's checking account, and they could have all their hard-earned money stolen?"  "How can we trust all the hundreds of thousands of retailers in the state to not abuse the information they will have access to when one of my constituents presents them with this card?"  "The information is encrypted? What does that mean? Is there some sort of standard in place for this encryption, and if these is, should we really trust it?" 

Indeed, electronic banking has been a part of our daily existence for decades, and we don't seem to worry much about this information being compromised, insomuch that we refuse to use a debit card to make purchases or to withdraw cash from an ATM.  Sure, we are more judicious in where and how we use it, but for the most part, people do this on a daily basis without much thought.  In the same way, the protocols and procedures that will be used to transmit this data (that has already been stripped of personally identifiable information by YOUR insurance company), are the same protocols used in electronic banking (protocol by National Institute of Standards and Technology).  Additionally, this system will go above and beyond those privacy mandates outlined by HIPPA Legislation.  If we do not trust this protocol for this healthcare information, then perhaps we need to revisit the same with banking. 

Again, as a healthcare consumer, I hope this bill passes, as it will mean more affordable healthcare for all Tennesseans.  As a taxpayer, I also hope this bill passes because it will create a way to measure the programs that my tax dollars are supporting.  I am not a doctor, but I believe that HB2289 will cure what ails us.