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APCDs Experience Limitations When Sharing Data: What Congress Can Do

The Senate’s Health Care Transparency Initiative recently asked stakeholders for feedback. This is the third in a brief series of posts sharing Freedman HealthCare’s recommendations to maximize the opportunity of APCDs and alleviate barriers to the broad sharing of actionable health care data. This post focuses on how Congress could support broader data sharing by APCDs. Here’s a brief explanation of two barriers and suggestions for action.

  1. Clarify Anti-Trust Rules Regarding Public Reporting of Price Information:

FTC Statement 6 safe harbor rules permit provider-specific cost reporting based on an aggregation of at least 5 providers’ data and a requirement that no single provider comprises more than 25% of the total. All other cases are to be evaluated on a case-by-case basis. This has a chilling effect. States and non-profit data stewards could implement price transparency more expeditiously and overcome objections more easily if they had a clear sense they would be not be subject to DOJ anti-trust action for publishing price data.

  1. Require payers to provide substance use disorder data for public health reporting, including price and quality:

SAMHSA quite rightly protects the privacy of persons receiving substance use disorder (SUD) treatment. These identity protections are well established in multi-payer databases, which collect many other types of sensitive data. Risk-averse payers interpret the SAMHSA rules quite broadly and therefore redact records throughout the dataset, for all settings of care, even when a SUD diagnosis is embedded in treatment records for unrelated services. As a result, MPCDs are not able to fully realize the price for SUD services or understand their utilization and lose an unknown amount of information about the price and utilization of other services. Here, Congress can offer guidance to SAMHSA about the need to allow payers to include this data in submissions to MPCDs.

You can read the full FHC letter here.

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