Why Health Insurance Claims Data Needs Medical Device ID

April 14, 2016 - If health insurance companies truly want to improve patient health outcomes including the quality of care and boost patient safety in an effort to reduce wasteful spending, it may be beneficial for health insurance claims data to include medical device identification details. Currently, health insurance claims data specifies which type of medical device implantation was performed on a patient but does not clarify which product was used.

While many know health insurance claims data as a way to pay for medical services between payers and providers, it can also be utilized by researchers, government policymakers,  and even health plans themselves to analyze the quality of care and prevent patient safety issues, according to The Pew Charitable Trusts.

While health insurance claims data can be used to track the safety of prescribed medication, it does not include identification of medical device products, which could greatly benefit patient safety, explained Dr. Josh Rising, Director of Health Care Programs at The Pew Charitable Trusts.

The federal government could help ensure patient safety is at optimal levels by requiring health insurance claims data to include information about the model and manufacturer of a medical device. Nine years ago, Congress did begin regulating implantable medical devices at a higher rate by requiring the Food and Drug Administration (FDA) to create a unique device identification (UDI) system, which consists of specific numbers.

Rising wrote about the lack of implantable medical device identification within current health insurance claims data and how including this information could even benefit the Medicare program by improving health outcomes and patient safety while reducing the costs of multiple surgeries if a medical device is defective in hip or knee replacement operations. Joint replacement surgeries cost the Medicare program approximately $7 billion every year.

Rising spoke with HealthPayerIntelligence.com to offer his background in the importance of medical device identification data for health insurance claims.

HealthPayerIntelligence.com: How would including medical device identification data improve analysis of insurance and Medicare claims data? How would it benefit patient care?

Dr. Josh Rising: “The medical device project here at Pew works to improve device safety by building a better system of post-market surveillance. Right now, insurance claims data can be used to answer a number of important health and patient safety questions.”

“For example, claims data contain information on prescription drugs that people are using. So you can use claims data to look at whether a drug might be associated with a particular side effect. Claims data can also be used to shed light on the performance of different doctors and different hospitals. They’re really a linchpin in the health data system to understand quality and performance.”

“Unfortunately, right now, claims data lacks any information on specific devices that are used in care. The claims data might indicate that a patient received a new hip or had two stents placed, but they don’t have any information on the specifics of which stent or which hip was used. If there’s a question about the performance of a product or if you’re trying to understand which hips are providing better care or what devices might have safety problems, right now, you’re unable to use claims data to look at those questions  in the way that you could use it for drugs or for many other health questions that you might have.”

HealthPayerIntelligence.com: Would medical device identification improve patient safety for Medicare beneficiaries? In what ways?

Dr. Josh Rising: “Having more information on the performance of devices would definitely improve patient safety. There have been some recent examples of some medical device failures that has taken us a long time to identify. These are metal-on-metal hips, cardiac defibrillator leads, surgical mesh, and a number of other products.”

“So if we had a system where we could identify problems with these products more quickly, we could then remove them from use and minimize the number of patients that were exposed to these devices. Including the UDI in claims will help get us that information. That’s a critical part of any system that will help us identify problems with devices and improve patient safety.”

HealthPayerIntelligence.com: How can payers and providers use insurance claims data to improve population health management?

Dr. Josh Rising: “Certainly, providers have a lot of choice in the device that they’re using, but sometimes it can be difficult to know what the right device for the right patient is. For example, does one type of hip work better in younger patients and another type work better in older patients? Or one better in men and one better in women? Right now, it is very difficult to help answer these questions that will then improve the outcomes for everybody. If we’re able to get better data such as through putting the UDI onto the claims form, that will really help us get that information that will let us answer those questions.”

HealthPayerIntelligence.com: In the midst of payment reforms like value-based care, how can medical device identification help providers improve data analysis and meet quality performance benchmarks?

Dr. Josh Rising: “The bottom line is that we’re increasingly moving to a world where providers will be held accountable for the outcomes of the patients that they treat and it’s going to be extremely valuable for providers to have better information on the products that they’re using because they are going to be held accountable for those outcomes. Building a system to provide that information will be extremely useful for providers in this new world.”

“That’s another reason why UDI in claims has seen support from a range of different stakeholders. A number of specific hospitals and health systems like Geisinger and Mercy have expressed their support for it. Payers like Aetna have talked about the value. Clinician groups like cardiologists, thoracic surgeons, and orthopedic surgeons have also talked about the value of making this happen.”

“I think the benefits are there for patient safety. They are there for accountable care organizations, which are looking for value. They are there for population health as well.”

“To point out, there have been a number of high profile reports recently that have looked at how to build a better device surveillance system and these reports have really highlighted UDI in claims as an important part of that surveillance system. FDA Commissioner Dr. Robert M. Califf, MD, has talked about the benefits of UDI in claims in a number of his recent comments as well.”