A prerequisite for reform: the need for enhanced ambulatory care data

As the recent national election demonstrated, the desire for health care reform emanates from a diverse constituency. The same dynamics that helped foster the growth in ambulatory services--lower costs and improved patient access to emerging technologies--dictate that any significant reforms include an increased role for ambulatory services. The strong correlation between health reform and enhanced ambulatory care generates a need for policy makers to model ambulatory care payment and utilization alternatives accurately. Unless action is taken, these modeling efforts will be significantly hindered by the current status of ambulatory care data. As the nation enters this period of transition and change, it is necessary to consider a lesson learned during the ill-fated voyage of the Titanic. The dimensions of the entire iceberg (i.e., all health care services), not just the portion that is most readily seen (i.e., inpatient services) must be considered. Consequently, enhancement of the capability to collect and analyze ambulatory care data is an essential prerequisite.