Meeting of the
Comprehensive Health Information System (CHIS) Advisory Council
Physicians Data Technical Workgroups
MINUTES
Date: March 29, 2006
Beginning Time: 10:10 a.m.
Venue: Face to Face at Tallahassee, Florida, and by teleconference
Members Present: Frank Astor, M.D., Blue Cross Blue Shield; James Bracher, J. Bracher &
Associates; Diane Godfrey, Florida Hospital; Mark Hauser, M.D.,
Baptist Hospital of Miami; Alma Littles, M.D., FSU College of
Medicine; Linda Quick, South Florida Hospital & Healthcare
Association; Lisa Rawlins, Agency for Health Care Administration; Kim
Streit, Florida Hospital Association; and Michael Wasylik, M.D., Florida
Medical Association
Members Present
by Teleconference: Brad Bjornstad, M.D., University Community Hospital Tampa
Members Absent: Larry McPherson, Department of Health.
AHCA Staff present: Cheryl Barfield; Penny Walker Bos; Arlesia Brock, PhD.; Cruz Conrad;
Beth Eastman; Michelle Johnson; Kevin Price; Beth Register;
Christopher Sullivan, PhD.; Gilmar Rodriquez; Jerome Todd; and
Carolyn Turner.
Other Participants: Nir Menachemi, FSU College of Medicine; R.H. Hahn, Vista Health
Plans; Marcos Lorenzo, TCH/FHA and Robert Wychulis, Florida
Association of Health Plans.
Other Participants
by Teleconference: Jim Puglise, Innovative Health Systems; Betsy Miller, HCA Health Care;
Tom Danzi, Tampa General Hospital; Mark Michelman, M.D., Florida
Medical Quality Assurance, Inc.; and Donald Gale, M.D. Winter Haven.
Materials Provided in Binder: Purpose and Roles for Hospital Acquired Infections Workgroup, Health
Plan Workgroup, Public Relations Workgroup and Health Care Facility Website/Ambulatory Surgery
Workgroup; Section 408.05 of Florida Statutes; CHIS Advisory Council Policies and Procedures; Role of
the Physicians Data Technical Workgroup; Massachusetts Health Quality Partners Website; DrScore.com
Frequently Asked Questions; UCompareHealthCare.com Frequently Asked Questions; Guiding Principles
for Physicians Data Website; AMA Measurement Sets; Physicians Data Website Wish List;
Ambulatory/Emergency Department Data Layout; Inpatient Data Layout; Ambulatory Care Quality
Alliance Pilot Project Press Release; Project Worksheet; Post Meeting Critique; Proposed Calendar for
2006.
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Draft Minutes of the Teleconference Meeting of the
Comprehensive Health Information System (CHIS) Advisory Council
Technical Workgroups March 29, 2006
Materials Provided at Meeting: Recommended Starter Set Clinical Performance Measures for
Ambulatory Care; Statutory Authority for Physicians Data Collection.
Welcome, Introductions and Roll Call: Lisa Rawlins, SCHS Bureau Chief, welcomed the members on
behalf of the Agency and Secretary Levine, and gave an overview of the SCHS and CHIS Advisory
Council. She continued with a brief review of her background in health care and the legislature and
thanked all for participating in the new Physicians Data Workgroup. Lisa Rawlins then introduced Robert
Wychulis, current Chair of the CHIS Advisory Council, who recognized Kim Streit, past Chair of the
CHIS Advisory Council, and thanked the members for their participation in the workgroup. Lisa Rawlins
then asked each member to introduce themselves and give a bit of background information, which they
did. Ms. Rawlins then introduced Penny Walker Bos, CHIS Administrator.
Agency Update: Penny Walker Bos reviewed the Florida Statutes and the CHIS Advisory Council
Policies and Procedures. Ms. Bos also explained the Florida Sunshine Law and how it affects the
workgroup members. Ms. Bos then continued by reviewing the other CHIS workgroups and the purpose
and roles for each.
Discussion of Physicians Workgroup Roles, Affiliations and Purpose: Lisa Rawlins then reviewed the
roles and tasks of the Physicians Data workgroup. She explained that she envisioned a workgroup that
would work on building a consensus statewide. She stated that the roles and tasks were flexible, and were
drafted to simply get the ball rolling, and can be updated as the group desired. Penny Walker Bos then
read the four tasks the Advisory Council had charged the workgroup with. Kim Streit questioned the
fourth role and the inclusion of the phrase “charges, revenues and expenses,” stating that she felt that
including revenues was irrelevant for the purposes of consumer awareness. Lisa Rawlins answered,
explaining that Secretary Levine’s vision is to use current resources to report physicians data similar to
hospital charges. Dr. Wasylik stated charges can be misleading because charges do not accurately reflect
what gets paid. Lisa Rawlins explained that drugs are listed brand name versus generic. Even though
pricing may not directly affect patients, it is a tool for comparison by the public. Diane Godfrey stated
that “charges” are a valid reporting tool for consumers to compare. James Bracher then suggested that the
group take a look at the first three roles and that the fourth would come into line eventually, stressing that
he felt the group should focus on what that have access to at the moment.
MOTION: Kim Streit made a motion, seconded by Dr. Brad Bjornstad, to remove “revenues and
expenses” from the fourth topic to be examined by the workgroup. After a vote by the members, the
motion was passed.
AMENDED MOTION: Diane Godfrey then made a motion to amend the motion to add “charges” to the
fourth item of the list of roles to replace “revenues and expenses”. Dr. Alma Littles seconded the motion,
and after a brief discussion, a vote was held, with Linda Quick, James Bracher and Dr. Mark Hauser
voting nay, and the remaining voting aye, the motion was passed.
AHCA TASK: The House sub committee on hospital acquired infections had a meeting scheduled for
March 29, 2006. AHCA staff is requested to provide a copy of the Congressional testimony for the
workgroup at the next meeting.
Executive Business: Lisa Rawlins called for nominations for the election of a Chair person, and
nominated Dr. Michael Wasylik. Dr. Wayslik accepted the nomination, and there being no other
nominations, on a motion by Kim Streit, seconded by Dr. Brad Bjornstad, Dr. Wayslik was elected Chair
of the workgroup.
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Draft Minutes of the Teleconference Meeting of the
Comprehensive Health Information System (CHIS) Advisory Council
Technical Workgroups March 29, 2006
Demonstration of Websites: Beth Eastman, AHCA, gave an overview of the three websites currently in
place, walking through each website demonstrating the various information, icons and links. Lisa
Rawlins pointed out the “practitioner profile” of the floridahealthstat.com website, and the credentialing
information, stating that it was not just doctors but ARNPs as well.
www.myfloridarx.com: Beth Eastman then reviewed the myfloridarx.com website, a collaborative effort
by AHCA and the Office of the Attorney General, and gave a demonstration on comparing prices for
prescriptions. She explained that it lists the top 50 drugs and generics and the retail prices submitted for
payment by Medicaid. Lisa Rawlins explained that there were some exclusions in the top 50 list. Penny
Walker Bos noted recent inquiries about our site from Texas and Colorado. Lisa Rawlins pointed out that
the website is a tool for consumers to encourage competition and is not a tool for fraud and abuse
oversight.
www.floridacomparecare.gov: Beth Eastman continued her review of the websites, focusing next on
floridacomparecare.gov by discussing the patient safety indicators, CMS SIP and Hospital Acquired
Infections. She pointed out that consumers can locate a facility by county or hospital name, and drill
down to get further information for that particular facility. Data updates are statutorily mandated
quarterly. Dr. Littles questioned the grade level of the information, and Ms. Eastman responded that the
site is written at a 10th grade level. Dr. Littles stated that this level was much higher than what is
recommended for consumer websites. Penny Walker Bos explained that the Public Relations Workgroup
was working on enhancements to the placement of links and information on the website, trying to expand
the outreach for feedback from consumer groups. Lisa Rawlins said that it was her vision that the website
be more of a navigational guide for consumers, with the goal to assist the consumer in navigating the
options available to their specific situation and diagnosis. She sees this website playing into the
physician’s website and connecting the information between the two. Beth Eastman continued her review
of the website, pointing out that Pediatrics will now be a separate search tool. Lisa Rawlins stated that
Florida is now the only state in the country to break out pediatric measures. She continued by saying that
one of the things this group will be looking at are suggestions for expanding the data collection sources
that currently exist. Members should look at legal issue that may prevent some data collection and see
how it can be expanded. Lisa Rawlins suggested that they may be able to look at Medicare and Medicaid,
as well as CMS for information. She suggested that Maine be used for presentation on physician’s
information process measures.
MOTION: Kim Streit made the motion to request for presentation of other state’s approaches to
Physician Data reporting. Dr. Littles suggested that this may be too much for the next meeting, and
requested that Staff provide a breakdown of other information available, including existing sources and
report back to the members. Kim Streit added that staff should include lessons learned. The motion was
seconded by Dr. Littles, and after a vote, was passed.
AHCA TASK: Research other states and health agencies that collect physician information to determine
what measures should be published on the website.
Demonstration of Massachusetts Health Quality Partners Website and other Sites: Michelle
Johnson gave a presentation of the HHQP website, noting that the website gave comparisons of doctors’
care. There was discussion about the site, and it’s features among the members. Dr. Hauser
recommended the Press Ganey Patient Satisfaction Poll, suggesting it may be a tool that could assist them
in determining how to display physicians data. He suggested that Staff research and provide members
with information on it and other customer satisfaction surveys.
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Draft Minutes of the Teleconference Meeting of the
Comprehensive Health Information System (CHIS) Advisory Council
Technical Workgroups March 29, 2006
AHCA TASK: Research Press-Ganey, Galop, and other customer satisfaction surveys and review
customer satisfaction measures collected on physicians.
Guiding Principles for Physician Website: Penny Walker Bos reviewed the Proposed Guiding
Principles for Website Design. Dr. Hauser suggested adding to the list “motivate organizations to do
better.” After some discussion it was decided to add “encourage individuals and organizations to
improve quality”.
AHCA TASK: Add verbiage to Guiding Principles for Physician Website document (“encourage
individuals and organizations to improve quality”)
AMA Measurement Sets: Penny Walker Bos began a review of the AMA Measurement Sets, its
mission and vision. Dr. Wasylik then led the group in a discussion on performance measures / metrics as
provided by the AMA.
AHCA TASK: Research issues of non-compliance (patients not following doctor prescribed
recommendations).
Lisa Rawlins discussed the ARHQ measures and how they had been applied in the other websites and
expressed that she was very comfortable with the science behind the measures. Kim Streit provided
members with a handout outlining Recommended Start Set Clinical Performance Measures for
Ambulatory Care obtained from AQA. She explained that the 26 measures were based on claims data, and
led the group in a discussion of factors to be weighed when determining measures. Lisa Rawlins pointed
out that the group should take advantage of the “low hanging fruit” - that information which is readily
available to them – and start from there. They should report on information already being collected, she
continued, stating that reporting on volume of procedures, such as for hospitals on
www.floridacomparecare could be reported on the physician level as well. Ms. Rawlins suggested that
the AQA Starter be second tier of information, and asked that the members concentrate on information
data sets currently being collected by AHCA.
AHCA TASK: Report on procedure counts for primary care physicians by procedure.
AHCA TASK: Report on volume of procedures by physicians.
Kim Streit expressed her concern with outcomes data and felt that the issue needs further review. She
suggested that they ask Dr. Romano from California to provide some insight on charge data and
complication data and how to apply to the physician level. Dr. Astor said that he felt claims based
information can compliment the information collected by the state. Jim Bracher stated he would like to
see inpatient data for hospitals and see what it looks like at the physician level.
AHCA TASK: Verify physician license numbers in database by comparing with DOH.
Website Wish List: Lisa Rawlins asked the group to focus on their wish list for what they would like to
see on the physicians website. Once the list is determined, she can provide the member with the data.
Linda Quick asked the members to put on the wish list things that are actual decisions that consumers
would use, such as procedures that people would actually be making decisions about.
MEMBER TASK: E-mail recommendations for the Website wish list. Dr. Tom Danzi, a member of the
audience from Tampa General Hospital, asked the group if anyone had asked the consumer what they
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Draft Minutes of the Teleconference Meeting of the
Comprehensive Health Information System (CHIS) Advisory Council
Technical Workgroups March 29, 2006
wanted to see on a website. Lisa Rawlins explained that in addition to the online survey currently in place
on all of the websites, the Public Relations workgroup are currently formulating a plan for focus groups
later in the year.
Jim Bracher suggested that the doctors in the group take a look at the information on the inpatient data
and look at what procedures could be utilized. He felt this would assist the workgroup in providing a list
sooner rather than later. When asked, Penny Walker Bos related that “inpatient data” would be to pull the
top 30 procedures where consumers select their physicians and have a list at the next meeting. Kim Streit
recommended using the volume information for elective procedures by ICD 9 codes that Carolyn Turner
did for the facilities and ambulatory surgery centers as a starting point. Beth Eastman referred the
members to the Ambulatory/Emergency Department Data Layout and Inpatient Data Layout as tools to
aid the members in determining what information is available. She provided suggestions such as volume,
primary procedures by CPT code, and APR-DRG. She suggested totals on high volumes on all to be
viewed by physician, which would be only “publicly reported physician data” and no quality statements,
allowing the consumer to determine from the information their own quality statement. Jim Bracher
suggested that there be a quality check to be sure that the correct physician data information is used.
Carolyn Turner stated that there could be a link with DOH to get specialty only, and run the data without
names.
Nir Menachemi, FSU College of Medicine suggested looking at diseases, which could follow a patient
through the entire procedure, and get information on all of the doctors involved in their care. Jim Bracher
requested that Staff talk to the legal department to determine if Medicare or Medicaid information is
available for use. Michelle Johnson stated that Medicaid encourages using the information as long as
they do not reveal private patient information.
Penny Walker Bos provided a handout of “Statutory Authority for Physician Data Collection” and
reviewed it with the members. She stated that this crosswalk provided a list of statutorily authorized
government agencies who collect health care data and what the law says about how that data can be used.
Dr. Astor offered that if the group could utilize the Medicaid and Medicare data, he could possibly
provide the algorithm, along with a list of the top 20 diagnosis that can be used as another list.
AHCA TASK: Research the availability of Medicaid claims based data for workgroup research.
MEMBER TASK: Research the availability of algorithm to research physician information using disease
categories.
Ms. Bos requested that the members email her with their ideas for the wish list, in addition to any other
suggestions or ideas for the workgroup.
AHCA TASK: E-mail members a reminder for wish list input with attached minutes, motions, and tasks.
Upon receipt, she will compile into one document and provide to the members along with a copy of the
minutes before their next meeting so that members could brainstorm on ideas to present at that meeting.
Meeting Evaluations: Penny Walker Bos reviewed the meeting evaluation critiques and urged members
to complete them and email them to her attention.
Next Meeting: Dr. Wasylik discussed potential dates for the upcoming meetings and suggested that the
next meeting be held some time in June. There was discussion among the members as to the location of
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Draft Minutes of the Teleconference Meeting of the
Comprehensive Health Information System (CHIS) Advisory Council
Technical Workgroups March 29, 2006
the meetings, and it was determined that they would be held in Tallahassee, however, the possibility of
having the meetings elsewhere would be considered. Upon a motion and second, the meeting was
adjourned.
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