Why Health Insurance Claims Should Include Medical Device UDIs

September 20, 2016 - More and more healthcare associations have been emphasizing the need to incorporate unique device identifiers (UDIs) from medical devices within health insurance claims. In fact, professionals from The Brookings Institution have spoken in favor of this in front of the National Committee on Vital and Health Statistics’ Subcommittee on Standards while The Pew Charitable Trusts sent a letter to the Subcommittee on Health Committee on Ways and Means advocating in favor of including UDIs on health insurance claims.

Dr. Greg Daniel, former Fellow and Managing Director at The Brookings Institution’s Engelberg Center for Health Care Reform, spoke in front of the National Committee on Vital and Health Statistics’ Subcommittee in June 2014 and discussed the importance of incorporating UDIs into health insurance claims work and other administrative resources.

During the summer of 2015, The Pew Charitable Trusts along with Aetna, Geisinger Health System, The Society of Thoracic Surgeons, and several other organizations sent a letter to the Subcommittee on Health Committee on Ways and Means thanking the agency for improving patient safety by creating a new medical device identification system. The letter also outlined the problems surrounding the fact that health insurance claims only list a surgical procedure and lack data on the model of the implant or the manufacturer.

Dr. Greg Daniel stated during his speech that using UDIs in administrative work would improve quality of care among patients with medical implants. As the healthcare industry focuses on achieving the Triple Aim, incorporating UDIs in health insurance claims could bring better outcomes and reduce rising costs by ensuring providers and payers have the most timely and accessible information available to them.

“Similarly health plans, health services researchers, and epidemiologists routinely use claims data to measure and track the impact of prescription drugs and other interventions on important outcomes in order to identify opportunities to improve the quality and value of health care. Since the claims data today cannot be routinely used to identify unique medical devices, these activities, including the Sentinel Initiative’s activities, are rarely conducted for medical devices if at all,” Daniel discussed some of the current issues with tracking medical device safety and quality.

“Further, while electronic health record (EHR) data and other sources of clinical data can be a rich source of clinical detail, their limited ability to collect data as patients move from provider to provider across the healthcare system renders them less useful for population level surveillance and performance tracking when used alone,” Daniel concluded.

In general, public health is being supported by the use of data stored in administrative resources and medical claims, said Daniel. When providers and payers gather data on all levels including health plan enrollment information along with pharmaceutical and clinical claims, more opportunities can be put forward with the potential for medical intervention to improve health outcomes on a population level.

One example that Daniel set up during his discussion is that of the FDA’s Sentinel Initiative, which looks at health insurance claims data to determine the safety and efficacy of drugs and vaccines among large patient populations. Essentially, the argument is made that patient safety will improve if UDIs are included in health insurance claims.

The letter from The Pew Charitable Trusts outlines how including UDI data within health insurance claims would assist researchers and FDA experts with analyzing information in much the same way as is conducted currently on prescription drugs and other medical procedures.

For example, the FDA could use this data to more closely study the long-term effects of medical devices. Once health insurance claims contain UDI data, then the FDA could more effectively evaluate both the safety of drugs as well as medical devices under the Sentinel Initiative. Additionally, payers themselves can use this data to better understand patient outcomes and cost, according to The Pew Charitable Trusts.

As previously reported in 2015, a total of 13 healthcare organizations sent a letter to Representative Kevin Brady (R-TX), Subcommittee Chair,  and Representative Bill Pascrell (D-NJ) discussing how specific information about the model of an implant and manufacturer should be included within the UDI tracking system in order to ensure safety problems are better monitored and recalls can be completed more quickly.

“The UDI system can provide claims with needed specificity to allow Medicare and other health plans, researchers and the FDA to conduct the same types of analyses for devices that are currently conducted on drugs and procedures,” the letter stated.

On a broader level, federal agencies will need to work together to ensure medical devices will receive the same safety procedures as pharmaceutical drugs. The research suggests that incorporating UDI information will help lead to better patient safety processes among medical devices.

Dig Deeper:

Why Health Insurance Claims Data Needs Medical Device ID

How Payers Should Prepare for Value-Based Reimbursement