Robert Wood Johnson responds to CMS' performance data reporting

The Robert Wood Johnson Foundation (RWJF) has submitted comments to the Centers for Medicare & Medicaid Services (CMS) recently on the proposed rule on Availability of Medicare Data for Performance Measurement, expressing support and constructive criticism for CMS' new authority to release Medicare data for reporting data measuring physician performance, called for under the Patient Protection and Affordable Care Act (PPACA).

In a letter to CMS Administrator Donald M. Berwick, MD, RWJF Senior Vice President and Director of the Healthcare Group John R. Lumpkin, MD, said the provision provides an opportunity to use Medicare data to support a variety of entities in its efforts to promote high quality care.

The U.S. faces an urgent need to improve the quality of healthcare while making the delivery of care less wasteful, more efficient and affordable, Lumpkin wrote, adding that a key piece to the delivery of care is information.

“Health professionals, purchasers, consumers, patients and others need timely, accurate, helpful information on cost and quality to make smart decisions that will help the nation achieve high value care," the letter stated. "Alternatively, without that information, we will not achieve the goal of maximizing value in healthcare.”

Given this importance, Lumpkin offered specific recommendations to strengthen the proposed rule, including:

• Maximize availability and minimize barriers. CMS should release data to the maximum extent possible, consistent with adequate protections for beneficiary privacy and data security. The proposed rule allows for the release of data to successfully apply qualified entity (QE) status that meets eligibility, operational and governance requirements and agrees to pay the CMS data fee. RWJF “strongly” encouraged CMS to balance the need for a “rigorous process” to identify QEs with the practical need for the release of data. Generally, CMS should ensure that QEs receiving the data have demonstrated appropriate experience and capacity to measure and report results. CMS also should focus on penalties for those few entities who might be irresponsible with the data. “The proposed rule, in some way, seems framed by a fear that the released Medicare data may in some way be harmful to providers,” Lumpkin wrote.
• Promote innovative uses of the information. The data used for publicly reported metrics have the potential to drive healthcare transformation and high value care, and CMS must guard against stifling innovation with exuberant oversight. Lumpkin added that it also is important to make data available in ways that others can readily use it to add value. “The proposed rule, unfortunately, misses potential opportunities to promote innovative uses of the data and in some instances may hinder innovation. Specifically, we strongly support the proposed requirement that QEs publicly report measures constructed from the data. At the same time, public reporting alone will not be sufficient to promote high value care.”
• Maximize transparency. Data will only be helpful if it is used widely by healthcare decision-makers. CMS should maximize the availability of the data where possible and not limit the data release to a single QE in one geographic area. “This data is a national and public resource,” Lumpkin wrote. “They should be available to as many QEs in a market as possible. Specifically, the rule should allow different QEs to produce reports based on Medicare data in the same geographic market. Consumers and other decision-makers can decide which presentation in their market best serves their individual purposes.”
• Be timely. For decision-makers to help work rapidly toward high value U.S. healthcare, they need the freshest possible data in usable, iterative cycles. “While the Medicare data has tremendous potential to promote and accelerate work toward high value care, the utility of the data decreases markedly if it is old or stale,” Lumpkin said. “For instance, a number of Aligning Forces alliances receive claims and clinical data from private and Medicaid sources that would be much newer and fresher than the Medicare data proposed here. Specifically, the rule should provide for the freshest Medicare data possible provided as frequently as possible.”
• Ensure affordability. CMS should ensure that data is affordable by those marketplace allies who are similarly working toward the same end. “Medicare data is a unique national resource with great potential to promote and accelerate work toward high value care. Most QEs that will be using the data for public reporting will be assisting the nation and CMS in that effort toward high value care,” Lumpkin wrote. “Those QEs will, in essence, be assisting beneficiaries and taxpayers in the public effort to improve the value of care. Consider, again, that an increasing number of entities prepare public reports, including all 16 of the Aligning Forces alliances. Most of those receive private commercial plan data.”