CMS Proposes to Release Medicare Data to Rank Physicians

July 6, 2011 – On June 2, 2011 CMS released proposed rules, as part of the Affordable Care Act (ACA), to allow organizations that meet certain qualifications access to patient-protected Medicare data.  These organizations will produce public reports on physicians, hospitals and other health care providers to identify which hospitals and doctors provide the highest quality, cost-effective care. 
 
The reports will enable consumers and employers to select higher-quality, lower-cost physicians and other healthcare providers in their area. Currently, Medicare claims data is not publicly available. Any comparison of physicians’ performance must come from single private insurance companies, which if ordered from each company, entails receiving multiple reports, some of which may be contradictory.
 
The qualified organizations will receive standardized extracts of claims data to evaluate the performance of providers of services and suppliers on measures of quality, efficiency, effectiveness, and resource use.  These organizations must have the capacity to process the data accurately and safely and would be required to combine the Medicare claims provided by CMS with private sector claims data to produce reports that are more representative of how providers and suppliers are performing.  Standard measures for evaluating the performance of providers would be required. These measures might come from entities such as the National Quality Forum indicators, which CMS uses for its Hospital Compare website. 

Health professionals would have the opportunity to review and correct data before the information is released publicly.  Organizations compiling the information must explain the methodology, statistical reliability and interpretation of the results.  The health professional would then need to request the Medicare data used to calculate the information he or she wants to appeal or correct.
 
The Medicare data would be stripped of personal information about specific patients but qualifying organizations would need to prove they are capable of using and securing all data received from Medicare Parts A, B and D claims data and will be subject to strict security and privacy processes.  These entities would also have to pay CMS for their data.
 
CMS will accept comments on the proposed rule until August 8, 2011.

Tags: Healthcare Reform