In March 2011, the U.S. Department of Health and Human Services released theNational Strategy for Quality Improvement in Health Care, which established three core aims to guide local, state, and national efforts to improve the quality of health care in the United States:⁷

Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.

Healthy People and Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.

Affordable Care: Reduce the cost of quality health care for...

The California Health Data and Advisory Council Consolidation Act¹⁹ (hereafter, the Data Act) gives OSHPD the authority to collect data on all hospital inpatients discharged from all licensed hospitals in California in order to “provide greater understanding of the characteristics of care rendered by hospitals.”²⁰ Among other required filings, an organization that “operates, conducts, owns or maintains” a hospital in California must file with OSHPD a “hospital discharge abstract record” for each patient discharge.²¹

Briefly, under the statute, OSHPD is charged with collecting the hospital discharge abstract records, identifying errors in the data, and guiding the reporting facilities toward compliance...

The RAND team sought to explore a range of legal, operational, and substantive issues associated with including a physician identifier in the California hospital discharge data set and the release of physician-identified data for a variety of potential uses. In particular, RAND wanted to understand whether stakeholders saw any benefits associated with physician-level measurement and reporting, to identify any operational issues or barriers to collecting physician identifiers and reporting physician-identified data, and to suggest strategies for addressing any identified barriers to advancing the collection of physician identifiers. To consider the range of issues, RAND used a multipronged approach (Figure 3.1)...

OSHPD has the authority to add a physician identifier to the hospital discharge data by issuing a notice of proposed rulemaking and taking into account public comments in making a final ruling, in accordance with the full requirements set out in the California Administrative Procedures Act. If OSHPD were to pursue the addition of physician identifiers, the agency would then have to comply with all statutory mandates related to the release of hospital discharge data—and would also have to decide whether to release physician identifiers where the statutes authorize but do not mandate release. Because the Data Act basically...

In this section, we summarize the findings from interviews we held with 16 California stakeholders and a follow-on phone meeting with 24 stakeholders to discuss the results of our interviews, identify other issues that were not raised during the phone interviews, and explore steps to address concerns. Figure 5.1 displays the organization of our presentation of the topics that were discussed with stakeholders.

California stakeholders varied in their knowledge about which identifiers are already being collected, either in California or nationally, and how those data are being released, reported, and used. Some stakeholders knew a lot, but many others’ knowledge...

Of the 48 states with hospital discharge data systems, 47 collect physician identifiers and use or release that information in various ways. RAND staff talked with informants in seven states about their hospital discharge data collection and data release experiences, focusing on physician identifiers.

No state informant reported any significant problems with collecting physician identifiers. The hospital discharge reporting systems are well established, and many have been operating for up to 30 years. Physician identifiers are standard fields on the UB-04 form, and most hospital discharge reporting systems draw from the information captured on this form. The UB-04 includes standard...

OSHPD has the statutory authority to add physician identifiers as a required data element to the hospital discharge data set after issuing a notice of proposed rulemaking and taking into account public comments in making a final ruling, in accordance with the full requirements of the California Administrative Procedures Act. If OSHPD were to collect the physician identifiers, OSHPD would be required to disclose the physician identifiers in keeping with all statutory mandates and would have to decide whether to release them in situations in which the statutes authorize but do not mandate release.

The two central policy questions are...