Medical insurers' billing claims can help researchers track patient complications

Billing claims from health insurance companies can provide insights on the long-term health of kidney transplant patients, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN).

The findings indicate that valuable health information can be obtained by analyzing medical insurers' reimbursement documents, a process that is much simpler and cheaper than many other forms of clinical investigation.

Patients who receive kidney transplants have an increased risk of developing a variety of serious complications, but transplant centers rarely collect detailed follow-up information on the health of organ recipients in readily analyzable formats. Researchers are therefore looking for information that may be available from other sources, such as from health insurance databases. Insurance companies' billing claims provide records of physician visits, hospitalizations, and medical procedures that could be used to conduct timely, cost-effective, and unobtrusive research on large populations.

To assess the ability of using billing claims to track transplant patients' long-term health, Krista Lentine, MD (Saint Louis University Center for Outcomes Research), and her colleagues compared information from Medicare billing claims from 571 transplant patients with information from actual patient medical records. They specifically looked at whether billing claims documented cardiovascular diagnoses and procedures as accurately as patients' electronic medical records.

The researchers found that combined use of Medicare billing claims from both Medicare Part A and Part B provided a sensitive record of cardiovascular events after kidney transplantation. The billing claims correctly identified 83.3% to 100% of cardiovascular events noted in patients' medical records. Documentation of cardiovascular procedures such as coronary bypass surgery and cardiac catheterization was particularly accurate.

The authors hope that this study will lead to future investigations on the value of billing claims in other types of research. Conducting randomized clinical trials is the best way to assess medical information, but these studies are expensive and time-consuming. Administrative data from insurance billing claims may help answer a number of clinical questions and describe health outcomes in large patient populations in an efficient and inexpensive way. Billing claims could be an attractive research tool at a time when the nation is striving to reduce medical costs while maintaining or improving quality.

The authors report no financial disclosures. Study co-authors include Mark Schnitzler, PhD, and Paula Buchanan, MPH (Saint Louis University Center for Outcomes Research); Kevin Abbott, MD (Walter Reed Army Medical Center); Kosha Bramesfeld, PhD (Saint Loius University Graduate School); and Daniel Brennan, MD (Washington University School of Medicine).

The article, entitled "Sensitivity of Medicare Billing Claims for Cardiovascular Diagnoses and Procedures among Kidney Transplant Recipients: A Comparison of Claims-based Case Definitions," will appear online at http://cjasn.asnjournals.org/ on June 18, 2009, doi 10.2215/CJN.00670109.