Is There Such Thing as Good Data?

It seems like half the time I write here, it’s some kind of rebuttal to a previous blog post by another DPC News contributor. I promise I’m not just a perpetual contrarian. We balance each other pretty well around here. I hope this post is just a clarification, not a contradiction.

While most of the writers here are physicians, Cristy Gupton is a benefits advisor–one of the good ones. She understands that DPC docs are deathly allergic to the word “data,” and she’s right.  At least when it’s used the way insurance companies have traditionally used it.  She argues for the value of data in her recent post: Did The North Carolina State Health Plan get it right? Not yet, but they still have time.  She even alludes to the fact that her discussion of “data” will probably trigger most of our readers.

When DPC docs say they hate “data” with every fiber of their previously-morally-injured souls, the data they hate is the garbage-in-garbage-out medical data and “quality metrics” that EMRs inside the system collect and report to insurers. It is always a time-consuming hassle, and once doctors submit it, insurance companies manipulate the data into excuses for not paying them. This is akin to the insurance company forcing a doctor to forge a knife the company then uses to stab them in the back. Of course we hate it!  

Although it’s true that “you cannot improve on that which you cannot measure,” the data-driven “quality measures” that such systems studied were perpetually inaccurate–thus a worthless waste of time. Inside the system, if a doc wanted to get paid and had patients who’s data (vital signs, A1C levels, etc.) would make them look bad, the docs or the people they worked for would simply change, massage, or delete the data. Or they’d fire non-compliant patients or not record the data likely to be bad, and like magic the “quality was great” and the money flowed. It was/is all garbage.  Nobody was rewarded for anything but being unethical.  
And even if it was good data, the idea that these numbers reflected a doctor’s quality level was utterly ridiculous. A doctor can give her diabetic patient Ralph all the good advice in the world, the best meds, prescribe exercise, whatever–but if Ralph just goes home, crashes on the couch and washes a box of donuts down with a 2 Liter of Pepsi, the doctor’s standard of care treatment will look pretty bad when that next A1C comes out.  And then she’s penalized for his behavior, which she can’t control. That’s why we hate “data” that insurance contracts forced (to say nothing of our patient’s confidentiality).

So, when Cristy writes “When the health plan in question is structured properly, data helps everyone at the table,” People like me instinctively bristle. Our sympathetic nervous system fires up (for you non-docs, that is the “fight or flight system”.  For DPC docs, however the sympathetic nervous system is called the “Fight or FIGHT System”.)  The hair on our back stands on end and we are ready to defend ourselves.

But Cristy continues, referencing an excellent talk by Dr. Gross, and it quickly becomes clear she’s not talking about the kind of data that puckers our o-ring–she’s talking about the emerging data that shows the success of DPC in saving everybody involved money.  This is data that insurers, employers, etc., can collect. Examples include decreases in healthcare spending for DPC patients, lower ER usage, and even decreases (if you can believe it) in insurance premiums for companies that purchase DPC for their insured employees.  This is not BS quality metrics, it’s objective measurement of what DPC docs have been saying since the beginning: “we cut healthcare costs–dramatically.”  (The only difference is now we see emerging objective proof, rather than people like me always just quoting the “T-bone” scene from Tommy Boy and urging my audience to “take my word for it.”)

So never fear, DPC docs–at least in this post, nobody is urging you to give anybody (insurance plan or otherwise) access to your EMR to mine data from it.  Nobody is planning to make you dig your own grave. As long as this is the kind of data she and other benefits advisors are talking about, Cristy is right when she says “It’s time for a more mutually agreeable definition of “data”.

The only other thing I have to say is to repeat my oft-cited opinion of the “seat at the table analogy”.  Cristy says “…the plan spends much less on many other things simply because [DPC] has the right seat at the table.” She’s right that inside the system, primary care docs don’t even have a seat at the table. They are the dogs begging at the ankles of those seated (insurance companies, PBMs, AMA, specialists, etc.), hoping for a scrap now and then. 

In my view, here in DPC, the table belongs to the docs and our patients. The seats are for those we choose to invite. Invited parties must focus exclusively on our patients’ best outcomes, and the invitations are exclusive, rare, and very easily revoked.