Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-19T07:53:15.378Z Has data issue: false hasContentIssue false

Data Collection, EHRs, and Poverty Determinations

Published online by Cambridge University Press:  01 January 2021

Abstract

Collecting and deploying poverty-related data is an important starting point for leveraging data regarding social determinants of health in precision medicine. However, we must rethink how we collect and deploy such data. Current modes of collection yield imprecise data that is unsuited for research. Better data can be collected by cross-referencing other sources such as employers and public benefit programs, and by incentivizing and encouraging patients and providers to provide more accurate information. Data thus collected can be used to provide appropriate individual-level clinical and non-clinical care, and to systematically determine what share of social resources healthcare should consume.

Type
Symposium 1 Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

See, e.g., Konnoth, C., “Health Information Equity,” University of Pennsylvania Law Review 165, no. 6 (2017): 1317-1376.Google Scholar
Braveman, P. and Gottlieb, L., “The Social Determinants of Health: It's Time to Consider the Causes of the Causes,” Public Health Reports 129, no. 2 (2014): 19-31.Google Scholar
ICD List, “Diagnosis Codes Index-Problems Related to Housing and Economic Circumstances (Z 59),” available at <http://icdlist.com/icd-10/index/problems-related-to-housing-and-economic-circumstances-z59> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
See Konnoth, supra note 1 (discussing 2008, 2010, and 2011 legislation).Google Scholar
Panel on Poverty and Family Assistance: Concepts, Information Needs, and Measurement Methods, National Research Council, Measuring Poverty: A New Approach (Washington, DC: The National Academies Press, 1995) (hereafter NRC Report).Google Scholar
Id. at 11 and 219.Google Scholar
Id. at 244-46.Google Scholar
Id. at 169.Google Scholar
Id. at 181-82.Google Scholar
Kaiser Family Foundation, Health Insurance Coverage of the Total Population, Timeframe: 2016, available at <https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B”colId”:”Location”,”sort”:”asc”%7D> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
45 CFR 147.120 (2011).Google Scholar
Prante, G., “Importance of Various Sources of Income by Age Group,” Tax Foundation, August 4, 2009, available at <https://taxfoundation.org/importance-various-sources-income-age-group/>.(last visited July 10, 2018)..(last+visited+July+10,+2018).>Google Scholar
Kaiser Family Foundation, supra note 12.Google Scholar
Cubanski, J. and Neuman, T., “Medicare's Income-Related Premiums: A Data Note,” Henry J. Kaiser Family Foundation, July 3, 2015, available at <http://kff.org/medicare/issue-brief/medicares-income-related-premiums-a-data-note/> (last visited July 10, 2018); see also “Means-Testing of the Medicare Part B Premium,” National Committee to Preserve Social Security and Medicare (July 2009), available at <http://www.ncpssm.org/Document/ArticleID/777> (last visited July 10, 2018) (“[T]he Social Security Administration (SSA) automatically determines the amount of the Medicare Part B premium using tax records filed with the Internal Revenue Service two or three years previously.”). (last visited July 10, 2018); see also “Means-Testing of the Medicare Part B Premium,” National Committee to Preserve Social Security and Medicare (July 2009), available at (last visited July 10, 2018) (“[T]he Social Security Administration (SSA) automatically determines the amount of the Medicare Part B premium using tax records filed with the Internal Revenue Service two or three years previously.”).' href=https://scholar.google.com/scholar?q=Cubanski,+J.+and+Neuman,+T.,+“Medicare's+Income-Related+Premiums:+A+Data+Note,”+Henry+J.+Kaiser+Family+Foundation,+July+3,+2015,+available+at++(last+visited+July+10,+2018);+see+also+“Means-Testing+of+the+Medicare+Part+B+Premium,”+National+Committee+to+Preserve+Social+Security+and+Medicare+(July+2009),+available+at++(last+visited+July+10,+2018)+(“[T]he+Social+Security+Administration+(SSA)+automatically+determines+the+amount+of+the+Medicare+Part+B+premium+using+tax+records+filed+with+the+Internal+Revenue+Service+two+or+three+years+previously.”).>Google Scholar
Application for Health Coverage & Help Paying Costs, Connect for Health Colorado, available at <https://www.colorado.gov/pacific/sites/default/files/Medaid%20and%20Child%20Health%20Plan%20Plus%20Paper%20Application%20-%20English.pdf> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
MAGI 2.0: Building MAGI Knowledge, Part 2: Incoming Counting, Centers for Medicare and Medicaid Services, September 1, 2016, at 36, available at <https://www.medicaid.gov/state-resource-center/mac-learning-collaboratives/downloads/part-2-income.pdf> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
“What is a Patient Portal?” Health IT, November 2, 2015, available at <https://www.healthit.gov/providers-professionals/faqs/what-patient-portal> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
Pomeranz, J., “Participatory Workforce Wellness Programs: Reward, Penalty, and Regulatory Conflict,” Milbank Quarterly 93, no. 2 (2015): 301-318. Admittedly, these programs are not without controversy. See Id.Google Scholar
Merit-Based Incentive Payment System Overview, Quality Payment Program, available at <https://qpp.cms.gov/mips/overview> (last visited July 10, 2017).+(last+visited+July+10,+2017).>Google Scholar
Memorandum Opinion, AARP v. United States Equal Employment Opportunity Commission, 226 F.Supp.3d 7 (U.S.D.C. 2016).Google Scholar
Konnoth, C., “Classification Standards for Health Information: Ethical and Practical Approaches,” Washington and Lee Law Review Online 72, no.3 (2016): 395-405 (suggesting an approach that allows patients to customize privacy preferences).Google Scholar
“Enabling Privacy: Data Segmentation,” Health IT, last updated September 25, 2014, available at <https://www.healthit.gov/providers-professionals/data-segmentation-overview> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
See, e.g., MacReady, N., “One in Five Patients Report Discrimination by Providers,” Medscape Medical News, WebMd, December 18, 2017, available at <https://www.medscape.com/viewarticle/890229> (last visited July 10, 2018).Google Scholar
Newman, J.C., et al., “The Differential Effects of Face-to-Face and Computer Interview Modes,” American Journal of Public Health 92, no. 2 (2002): 294-297.Google Scholar
See Konnoth, supra note 1 (explaining the learning health system).Google Scholar
McCabe, B.A., “Barriers to Adherence in a Free Medication Program for Low Income Individual with Type 2 Diabetes,” LSU Doctoral Dissertations (2003): 3679; Kurlander, J.E. et al., “Cost-Related Nonadherence to Medications Among Patients with Diabetes and Chronic Pain,” Diabetes Care 32, no. 12 (2009): 2143-2148.Google Scholar
Scott, A.R., et al., “Surgical Follow-up Costs Disproportionately Impact Low Income Patients,” Journal of Surgical Research 199, no. 1 (2015): 32-38.Google Scholar
Delia, D., “Post-Discharge Follow-up Visits and Hospital Utilization by Medicare Patients, 2007-2010,” Medicare and Medicaid Research Review 4, no. 2 (2014): E1-E19.Google Scholar
Jones, C.A., “Cardiovascular Disease Risk Among the Poor and Homeless — What We Know So Far,” Current Cardiology Reviews 5, no. 1 (2009): 69-77.Google Scholar
See Konnoth, C., Medicalization and the New Civil Rights (Working Draft, on file with author).Google Scholar
Fox, J. and Thompson, R., “Clinical Decision Support Systems: A Discussion of Quality, Safety and Legal Liability Issues, Proceedings AMIA Symposium (2002): 265-269.Google Scholar
Konnoth, C., Medicalization, supra note 32.Google Scholar
Mugavero, M. J. et al., “The State of Engagement in HIV Care in the United States: From Cascade to Continuum to Control,” Clinical Infectious Diseases 57, no. 8 (2013): 1164-1171.Google Scholar
Pence, B. W., et al., “Falling through the Cracks: The Gaps between Depression Prevalence, Diagnosis, Treatment, and Response in HIV Care,” AIDS 26, no. 5 (2012): 658.CrossRefGoogle Scholar
Performance Evaluations: What is working in Accountable Care Organizations? Premier Research Institute, October 27, 2016, at 11, available at <https://www.premierinc.com/wp-content/uploads/2016/10/What-Is-Working-In-ACOs-Report-10.16.pdf> (last visited July 10, 2018).+(last+visited+July+10,+2018).>Google Scholar
Matthew, D. Bowen, The Law as Healer: How Paying for Medical Legal Partnerships Saves Lives and Money, Center for Health Policy at Brookings, January 2017, available at <https://www.brookings.edu/wp-content/uploads/2017/01/es_20170130_medicallegal.pdf> (last visited July 10, 2018).Google Scholar
Gottlieb, L. M. et al., “Moving Electronic Medical Records Upstream,” American Journal of Preventative Medicine 48, no. 2 (2015): 215-218, at 216.CrossRefGoogle Scholar
Roberts, E. T. et al., “The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities,” Annals of Internal Medicine 168 no. 4 (2018): 255-265, available at <http://annals.org/aim/article-abstract/2664654/value-based-payment-modifier-program-outcomes-implications-disparities> (last visited July 10, 2018).CrossRefGoogle Scholar
The kind of approach I seek to suggest is analogous to the one here. Markovitz, A. A. et al., “Risk Adjustment May Lessen Penalties on Hospitals Treating Complex Cardiac Patients under Medicare's Bundled Payments,” Health Affairs 36, no. 12 (2017).CrossRefGoogle Scholar
Baum, F. E. et al, “Changes Not for the Faint-hearted: Reorienting Health Care Systems toward Health Equity through Action on the Social Determinants of Health,” American Journal of Public Heath 99, no. 11 (1999): 1967-1974.Google Scholar
See, e.g., Bazzano, A. N. et al., “Factors Associated with Vitamin D Status of Low-Income Hospitalized Psychiatric Patients: Results of a Retrospective Study,” Neuropsychiatric Disease and Treatment 12 (2016): 2973-2980.Google Scholar