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some revealing stories for counties with much larger populations, too. Houston internist Lisa Ehrlich, MD, president of the Harris County Medi- cal Society, says the county has “super- utilizer” patients who in some cases visit the emergency department as many as 250 times during a one-year period. “It’s absurd,” said Dr. Ehrlich, a member of TMA’s Council on Health


Care Quality. “But if you can identify ^RY]O KXN cY_ Q_\O ]c]^OW] Y_^ ^RK^ can mitigate that, whether it’s giving them a place to stay and having tele- medicine … or social worker outreach to make sure they’re taking their med- icine, it’s totally worth it, because 250 visits to the ER is superexpensive.” A 2013 National Institutes of


Health study of more than 8,000 out- patient emergency department visits


during 2006–08 found the average charge per visit was $2,168, with a me- dian charge of $1,233. A regional map of the annual cost


of care for commercial insurance in 2011, provided by the center, shows an example of what UTHealth research- ers can do once they get the Medicare data. (See “Using the Data,” page 48.) The center previously had obtained 2011 Medicare data for another proj- ect, and the variations in that data provided a glimpse into Texas’ health disparities. “It changes by whether you’re in a


metropolitan area or you’re in a rural area or you’re in the Rio Grande Valley, and some of those things just logically should not change for those kinds of reasons,” Dr. Krause said. “What it re- ally brings home is that there may be some very important social determi- nants of health that have to be consid- ered. Especially when we’re looking at moving more toward the value-based health care system; you have to look at all of the issues that impact health.” Although the center already has been certified, in September it still was in the process of completing two more phases of application to demon- strate to CMS that it has the proper se- curity requirements in place to house the claims data. It was hoping to com- plete that process by late October and hear from CMS again by December. The center is seeking data from 2012 onward.


WHAT ANOTHER STATE LEARNED


As it begins its work, the Center for Health Care Research Data can look PY\ Q_SNKXMO P\YW Y^RO\ [_KVS ON OX- tities that have benefitted from the certification for several years. The Oregon Health Care Quality Corp., an SXNOZOXNOX^ XYXZ\Y ^ KV]Y UXYaX K] ; -Y\Z RK] LOOX MO\^S ON ]SXMO Q Corp integrated the data it re-


ceived from Medicare into both its public reporting system for consum- ers and its private reports for practi- tioners. Q Corp provides its reporting to most of the primary care clinics in


50 TEXAS MEDICINE November 2017


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