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Business, Free Enterprise and Constitutional Issues; Pro-Life and Pro Second Amendment. Susan Lynn is a member of the Tennessee General Assembly. She serves as Chairman of the Consumer and Human Resources subcommittee, a member of the Finance Ways and Means Committee and the Ethics Committee. She holds a BS in economics and a minor in history.

Thursday, May 21, 2009

All Payer Claims Database update

Tennessee state government wants to get into the healthcare business big time! There is pending legislation to collect all of the data on your privately paid for healthcare transactions.

The Governor’s administration is pushing HB2289. As amended the bill claims that the state government needs your information to;

“Improve the accessibility and affordability of patient health care and health care coverage”

“Identify health and health care needs and inform on health and health care policy”

“Determine the capacity and distribution of existing health care resources”

“Evaluate the effectiveness of intervention programs on improving patient outcomes”

“Review costs among various treatment settings, providers, and approaches”

“Provide publicly available information on health care providers’ quality of care”

The plan is to mandate that your insurance company transmit all of your healthcare transactions to the state. You will be assigned a unique encrypted patient identifier by your insurance company. This identifier will be used by the state to track all of your healthcare transactions so that they can evaluate you according to the criteria listed above. Your doctor will also receive a unique healthcare provider identifier; but he or she will be fully identifiable.

What if you should want to opt-out? Well, you can’t. We tried very hard in the House Government Operations Committee this week to make that possible for you and your doctor but we were defeated on a party line vote. Should your insurance company refuse to comply with handing over your information it will receive a $100.00 per day fine from the state.

I want you to understand the breadth and the enormity of this plan. I asked just one of the major health insurance companies in Tennessee how many claims they process. 32,000 per hour; or 256,000 per day was the answer.

So I ask you to consider; why does the state of Tennessee need that much data, and that much detail about your healthcare transactions?

I asked a few public policy groups to take a look at the legislation. They responded with alarm. Some of their comments are that “…this is an avenue to centralized control over medical decisions...and the building of a brand new expensive bureaucracy that will use the data to issue reports to further secure their control over medical decision-making.” And, “Whoa. This bill is very scary. Not only is there no opt-out provision, but looking at claims data is the way to implement price controls.”

From what I’ve been able to learn several states have recently instituted similar databases and several more are considering bills at this time. Most all use a company called the Maine Health Information Center which is affiliated with the National Claims Data Management System. These are non-profit organizations set up to accept and analyze massive amounts of healthcare data.

Recently a similar plan was instituted in Minnesota. The cost was $1.2 million for the databasing of claims data on all Minnesotans for just the first 18 months. Additional costs for analyzing the data are $3.0 million dollars per year.

Yet the state of Tennessee claims that this bill will cost Tennessee little more than $200,000 per year. Perhaps that is because the bulk of the cost is borne by your insurance company.

I fail to see how legislators mandating insurance companies to turn over your healthcare transactions to the state cannot violate the Fourth Amendment to the US Constitution; unreasonable searches and seizures. Surely, passage of this legislation would constitute a seizure by the state of Tennessee of private, and privately paid for detailed information for which the state has no business having and for which they have no compelling, rational or legitimate use.

Outgoing administrations often start thinking of their next job early. Perhaps the Governor and some of his cabinet members have big plans in the ever growing healthcare information field.

I hope that you are concerned about this bill because your voice does make a difference. This is one bill that should go away. Please take the time to contact your legislator to learn more and to express your feelings about this legislation; http://www.capitol.tn.gov/.


Anonymous said...

Susan, I see this as definite infringement on our privacy and a huge cost to our economy.

Thank you for bringing this matter to our attention.

Toni Kihara

Zach said...

Thanks for the info...just shot an email to my Rep's. Asked if they were OK with going againist our Founding Father Ideas' on unreasonable searches and seizures. Thanks and keep up the fight. One question what happen to the Charter schools bill?

Stephen Foster DDS said...

We do not need more intrusion into the Doctor-Patient relationship. With the stimulus plan recently passed money was appropriated to establish computer infrastructure to handle this type of information directly from the doctor in the treatment room. Now we this plan working down for the insurance side of the health care system. This is just the incremental approach to government controlled healthcare.

Also with Obama and the Democrat's announcement to tax health insurance plans to pay for the noninsureds coverage, this is exactly the system that would be needs to collect the information used to determine and calculate this new tax.

Enough is Enough!

Meri said...

I just wrote my state Rep. and Sen. saying support Constitutional Convention and defeat HB2289. I'm taking back my country starting with TN.

Anonymous said...

"So I ask you to consider; why does the state of Tennessee need that much data, and that much detail about your healthcare transactions?"

Susan, read page 14 & 15 here for your answer.

Did your public policy sources not agree to have their identity disclosed? How can we trust what you've written is true?

The cost will probably be more than $200,000 but it's a small price to pay if the overall goal is to reduce health care costs.

"I fail to see how legislators...cannot violate the Fourth Amendment to the US Constitution..."

As long as the patient identity remains anonymous, I see no reason why the process of data collection violates the "privacy" of any individual. Without the personal identity attached to the data, there is no way to prove that any one person's privacy has been violated, thus the 4th Amendment is not being violated.

"...and for which they have no compelling, rational or legitimate use."

see the link above

Your own
shows that you've not initiated one single piece of health care legislation since being elected to office.

I'm just having a hard time trying to find your credibility on the health care issue, specifically how to reduce health care costs in the state of Tennessee. Where is your bill to help Tennessee reduce health care costs? 7 years and counting...I've seen nothing.

Representative Susan Lynn said...

Thank you for writing. Obviously, I am more jealous of your privacy than you are, however, I am very happy to be so. If you'd like to sign a consent form to give the government your data I don't see why you shouldn't be able to do so. Nor do I see why those who do not wish to consent should be prevented from declining.

Who says the government is expert at determining the right thing to do about the cost of anything? I have never seen any evidence that government is capable of solving such problems.

My web site is fixed.

The public policy group commenter’s are Twila Brase, President, Citizens' Council on Health Care and Christie Raniszewski Herrera, Director, Health and Human Services Task Force for the American Legislative Exchange Council. However, since from these ladies I have heard from other groups that I have not yet quoted.

Let me ask you, would you allow the state government to occupy an unused room in your home so that employees could listen to your private conversations on the chance that they may glean some information that might help you or others in the future?

How strong is your sense of the right to self determination? That which our great experiment called the United State of America was largely predicated.

Anonymous said...

But if there is an opt out, then the data won't be accurate. It needs to be all inclusive if you really are serious about cutting health care costs. Like the census for determining the social and demographic trends of our nation.

"Who says the government is expert at determining the right thing to do about the cost of anything? I have never seen any evidence that government is capable of solving such problems."

I believe that government can provide an alternative method to markets for supplying goods and services when it appears that the benefits to society of doing so outweigh the costs to society. However, a government policy to correct a market imperfection is not justified economically if the cost of implementing it exceeds its expected net benefits. This is the reason why accurate data must be collected in order to repair our broken health care system. We can't spend any money to correct the problems if we don't have the data to accurately reflect exactly what those problems entail.

The WHO has us at 37 for the US health care system. Maybe you're ok with that. I'm not.

My personal belief is that if cutting health care costs can increase the overall health of our nation as well as grow the economy, we should try every effort (including limited government involvement) to do so. I have not seen any effort on your part over 7 years. If politicians in government let health care costs get out of control (which they've done), I don't see how US citizens can enjoy the "life, liberty and pursuit of happiness" guaranteed to us. Most of us risk becoming in debt for basic health care services without insurance and if we are lucky enough to have health insurance, we still have to pay unrealistic premiums. Maybe you're ok with insurance companies being in control as the gatekeepers of our health care costs, but I'm not.

Your analogy is a form of fear. It has nothing to do with the issue at hand.

I want the state to have all the information they need to determine, along with insurance companies, other private entities and our own state citizens on how to best to set up a successful health care system. Without the data, we are letting the insurance companies win. If you are so afraid of the state, then why don't you start something yourself outside of state government?

How strong is YOUR self determination? You are in control. You have been given the power to lobby for us, the citizens, not the insurance companies. You have not introduced one piece of health care legislation. Some would say you have let the insurance companies run wild for the last 7 years in our state. You can say "no" all you want to any state government involvement with health care, but you have done nothing yourself to help Tennesseans in the way of receiving affordable health care. And then you have the audacity to say no to a sensible proposal, all based on fear.

Anonymous said...

Citizens' Council on Health Care
makes no mention of reducing health care costs as one of its goals on its website. That's a disgrace.

The American Legislative Exchange Council is comprised of 2/3 majority of Republicans and 1/3 of Democrats. Even though they claim they are a nonpartisan organization, I beg to differ.

"Who says the government is expert at determining the right thing to do about the cost of anything? I have never seen any evidence that government is capable of solving such problems."

Susan, your own
should help reduce overall health care costs.

Read from this


Cost-Benefit Analysis

Costs and benefits of a routine PCV7 program for healthy U.S. infants and children were evaluated in a study using current estimates of pneumococcal disease burden (i.e., meningitis, bacteremia, pneumonia, and AOM episodes), clinical outcomes, vaccine efficacy, and health-care costs [107]. Sources of clinical outcomes and costs included published and unpublished data, expert consensus, and computerized databases from Kaiser Permanente of Northern California. For each annual U.S. birth cohort, routine PCV7 vaccination is estimated to prevent approximately 12,000 (78% of potential) cases of pneumococcal meningitis and bacteremia; 53,000 (69% of potential) pneumococcal pneumonia cases; and >1 million (8% of potential) episodes of clinically diagnosed otitis media. Vaccination of healthy infants would result in net savings to society if vaccine costs were <$46/dose. Net savings to health insurers would result if the vaccine costs were <$18/dose. A program in which one dose of vaccine was administered to children aged 24--59 months to bring them up-to-date with their vaccinations would result in societal cost savings at a vaccine price of <$80 for children aged 24--35 months and <$50 for those aged 48--59 months. From the health-care--payer perspective, savings would result if vaccine costs were <$40 and <$20 when administered to children aged 24--35 months and 48--59 months, respectively. Results of this study demonstrate that cost-effectiveness of vaccination of infants and toddlers is most influenced by vaccine price, especially among children aged >24 months. In a recent reanalysis of cost-effectiveness of PCV7 using additional and updated information (including newly available safety data, national costs, and rates of tympanostomy tube placement), the same investigators found that break-even costs for vaccination of infants from societal and health-care--payer perspective were $40 and $17, respectively [108].

You took evidence based on accurate data and introduced a law based on that evidence. If one disallows evidence based on flawed argument of "privacy" (because the patient's identity will remain private as stated in the bill) we will get nowhere in trying to solve our other numerous health care problems.

So I apologize in saying that you've done nothing to help curb costs. You've helped even if it is just a small bit. I also don't believe you haven't seen evidence of government solving such problems of (future or present) high health care costs. Why else would you introduce your bill?

Let's hope the bill gets out of subcommittee and passes because I wonder what would be the cost of caring for the health (or sickness) of infants without your bill being passed? ;)