<ul>
<li><b>Facts:</b>
<p>
<ol>
<li>Businesses providing medical services pass their costs on to patients or insurers.
<li>Businesses keep track of the decision making variables impacting costs.
<li>Businesses keep track of the decision making variables impacting revenue.
<li>Businesses must be able to present a legitimate bill to recover costs.
<li>Individuals do not keep rigorous records regard medical services as much of the cost of those services are covered by insurers.
</ol>
<p>
<li><b>Proposal:</b>
<p>
For the above reasons the best way to compute total health costs involves making use of corporate data solely to the exclusion of patient-reported data.  
<p>
Currently, national health costs are computed from data collected in a household component matched with data collected in a provider component.  This is a very expensive and time consuming process involving:
<ol>
<li>sampling the household population
<li>doing field data collection on the household sample
<li>sampling the providers identified in the household data collection
<li>contacting the providers to obtain health cost information for the household members
<li>matching the household and provider data
<li>resolving differences and imputing data as necessary
<li>generation of estimates based on weighted data
</ol>
<p>
The alternative being proposed involves the following:
<ol>
<li>sampling the provider population
<li>contact the sampled providers
<li>collect the following classes of data
<ul>
<li>total revenue for the study year
<li>revenue by interesting classes (e.g. outpatient, inpatient, surgery, etc.)
<li>revenue by ICD, CPT, etc.
<li>who paid by interesting classes (private insurance, medicaid, medicare, individual)
<li>patient demographics (gender, ethnicity, income etc.)
</ul>
<li>generation of estimates based on the weighted data
</ol>
<p>
It will be possible to cross-check the calculated estimate with IRS reported revenue data to ensure the reliability of the estimate.
<p>
<li><b>Detail:</b><p>
<ul>
<li>Data points (per event):<p>
<ul>
<li>gender
<li>ethnicity
<li>birth year and month
<li>income (if available)
<li>event beginning date
<li>event ending date
<li>event type  
<li>event code
<li>event cost
<li>event sources of payment
</ul>
<p>
<li>Provider Responsibilities:<p>
<ul>
<li>Keep electronic data
<li>Code all medical events
<li>Prepare an export file of the electronic data (encrypted)
<li>Transmit the file to the contractor
</ul>
<p>The export would be an export of all medical event records for the study year.  So, no filtering by patient would be necessary.  Also, once a provider has developed the script to export the data points, the export program would simply need to be run for each subsequent year.
<p>
<li>Contractor Responsibilities:<p>
<ul>
<li>Prepare the provider sample frame
<li>Select the provider sample
<li>Maintain the provider sample file
<li>Contact the provider
<li>Receipt the encrypted files
<li>Import the encrypted files
<li>Clean and edit the data
<li>Prepare aggregate file
<li>Generated estimates
<li>Coordinate with DHHS
</ul>
</ul>
<p>
<li><b>Summary:</b>
<p>
Since the proposed data collection model does not involve tracking medical events at the patient sample level, the work of preparing the estimation files is much reduced.  
<p>
Using the demographic info for the provider medical events, it will be possible to associate the costs for those patient classes with other national study data at the aggregate level.  
<p>
Also cost estimates for classes of medical events may be computed using the ICD and CPT codes.
</ul>
