CMS to publicly report provider performance

By Mary Mosquera
02:35 PM

The Centers for Medicare and Medicaid Services (CMS) intends to allow certain organizations access to Medicare claims data to produce public reports that will offer consumers and employers a more accurate snapshot of the performance of physicians and hospitals.

These reports, combined with private sector claims data, will identify the hospitals and physicians with the highest quality and cost-effective care, the agency said in announcing its proposed rule June 3.

The proposed rule supports efforts of the health reform law to improve healthcare quality and lower costs. CMS will formally publish it in the June 8 Federal Register and accept public comment for 60 days.

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The public reports will contain aggregated information only and no individual patient data will be shared.

“Making more Medicare data available can make it easier for employers and consumers to make smart decisions about their health care,” said Donald Berwick, MD, CMS administrator, adding that “making our health care system more transparent promotes competition and drives costs down.”

Currently, employers, consumers, providers and quality measurement organizations have had limited availability to healthcare claims data. As a result, health plans create provider performance reports based solely on the health plan’s claims, which may account for only a fraction of the provider’s patients.
Providers can receive multiple and sometimes contradictory reports from a variety of insurers. Often, providers are unable to appeal or correct inaccuracies in the reports, CMS said. 

The proposed rule seeks to change that situation with provisions that govern the release and use of standard extracts of Medicare claims data that CMS will supply to measure provider performance and that explain how organizations can qualify to receive those data extracts.

Organizations that are qualified to crunch the data accurately and in a manner safeguarding patient information would combine the Medicare and private sector claims data to produce quality reports “that are more representative of how providers and suppliers are performing,” according to CMS.

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The proposed rule includes strict privacy and security requirements for organizations handling Medicare claims data. To prevent mistakes, the qualified organizations will share the reports confidentially with the providers prior to their public release to offer them the opportunity to review and make necessary corrections.

The proposed rule follows on recent health reform efforts announced in April, including the Hospital Value-Based Purchasing initiative to reward hospitals for the quality of care for Medicare beneficiaries and to help reduce costs.

The Partnership for Patients calls on providers, pharmacists, employers, union and government to cut medical mistakes and adverse events with the goal initially of saving 60,000 lives over the next three years.

CMS will also pay Accountable Care Organizations (ACOs) to improve the coordination of patient care with expected improved results and lower costs.