Mandatory vs. voluntary All Payer Claims Database bills advancing

10 February 2012

Del. John O’Bannon, M.D.’s bill to create an all payer claims database (APCD), HB 343, and Sen. Toddy Puller’s bill, SB 135, to do the same, are at odds with each other. The purpose of the APCD is to facilitate data-driven, evidence-based improvements in access, quality and cost of health care through understanding of health care expenditure patterns and operation and performance of the health care system.

Del. O’Bannon’s bill would mandate submission of claims data by health plans, where Sen. Puller’s bill would establish a voluntary program. Under Sen. Puller’s bill, if certain milestones for data submission are not met, a process to mandate health plan participation in the APCD would be initiated.

Talks among stakeholders, including the health plans and health systems on how to approach the issue of data submission are on-going.

The Medical Society of Virginia (MSV) is closely monitoring the APCD legislation to ensure that protections we achieved already that health care providers cannot be assessed any fees to fund the APCD (though there would be fees if physicians were to subscribe to or request information from the database) are maintained. MSV will also guard against any efforts to change the fact that the legislation specifies that no provider-specific, facility-specific or carrier-specific reimbursement shall be disclosed or reported.