They’re Watching You: It’s Creepy and Obsessive—Here’s How to Live With It

Take-Home Messages

  • Know your data.
  • Your data are being collected, it’s being publicly reported, and often you are the last to know what it says about you and your practice.
  • Knowing where to find the data and how to stay on top of it are both key.

Every breath you take
Every move you make
Every bond you break
Every step you take
I'll be watching you
--The Police

Cathleen Biga, RN,CEO of Cardiovascular Management of Illinois wants you to know they are watching you. In this case, “they” are an ever-expanding group of public and private data “police” who are collecting and then publicly reporting these data for purposes of transparency. It’s as creepy and obsessive as the 1983 #1 record by The Police—with potentially even more sting.

In a presentation at ACC.12, Ms. Biga listed 34 organizations collecting and presenting publicly reported data on you, your hospitals, and your patients. The challenge is how to get your arms around such a huge amount of data. How much of it is accurate? How much of it do you really want out there on the Internet about you? Is your administrative team working to make sure the data you are submitting are accurate?

Data Everywhere, No Sense Anywhere

The National Cardiovascular Data Registry (NCDR®) offers valuable information, but it may not be getting to the very people who could benefit the most. At an NCDR data meeting held in Chicago, less than one-third of the 900+ people attending shared the data with their physicians. Later, in a presentation for clinicians, Ms. Biga said, “If you do nothing else, when you leave here next Tuesday, go knock on a door and take a look at your cath/PCI data, your ICD data, any data they have collected on you. It’s reflecting what you do.”

Where do you find the data? Ms. Biga suggested:
  • First and foremost, know all your data sources (Internet-based, CMS, private payers, etc.)
  • ─ Where are your readmission data and core measure data coming from?
  • Identify processes of how you collect the data
  • ─ Who abstracts?
    ─ Who interprets inclusion and exclusion? Typically, different people will interpret them differently.
    ─ Who validates your data? It’s an important part of your internal quality process to make sure you are validating and auditing your data.
    ─ Who audits?

Besides getting on top of the data, she recommends:
  • Getting on top of coding
  • Focusing on quality
  • Understanding how you are being judged and what you are being judged on
  • Understanding hospital bureaucracy
  • Recognizing silos
  • Appreciating incentives
  • Aligning incentives

Everybody is looking at your data. They are looking at whether you are putting in dual-chamber pacemakers when you should be putting in single-chamber pacemakers. They are looking at whether ICD placement is appropriate. For that matter, they are watching to see how well you are doing documenting the appropriateness of what you do. Usually, it’s not whether you are doing inappropriate procedures; the more common problem is correctly coding what you do—you may be following the criteria closely and then someone is coding it wrong.

One important question: “Who’s watching patients while we’re collecting all this data?” Ms. Biga said, “We’ve got everybody watching us, but the key is to streamline this and make it effective and efficient on an ongoing basis.” Then, you can concentrate on your patients.

Keywords: Illinois, Police, Clinical Coding, Data Collection

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