AIM: Will releasing Medicare data help improve care?
As belts keep tightening to contain healthcare costs, most are looking for creative and innovative ways to improve healthcare, and the Centers for Medicare & Medicaid Services (CMS) may have found one. The solution? CMS will make Medicare claims data available to rate doctors; however, most are asking whether this solution will hold any benefits.
“On Dec. 5, 2011, the CMS announced that it will make its claims data available to rate healthcare providers on their quality of care,” wrote Rachel M. Werner, MD, PhD, of the Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, both in Philadelphia, in an ideas-and-opinions piece featured Feb. 13 in the Annals of Internal Medicine. “The goal of availing these data to the public is to enable consumers to make more informed choices about their healthcare providers.”
What will the rule entail? Qualified organizations such as consumer groups, employers and insurers will now have access to Medicare A, B and part D billing data. But only those who apply and are deemed appropriate in using such data to create performance reports will be allowed to view data.
“The qualified organization can then use these data to identify high-quality healthcare providers or create online tools to help consumers choose a provider,” wrote Werner.
Werner said that making these data available could be a “gamechanger” for healthcare due to the fact that Medicare covers more procedures, office visits and hospitalizations than any other entity. “Use of these data on healthcare interactions provides the opportunity to expand the quality and breadth of available performance measures,” she wrote.
But while Werner wrote that the release of these data may be an important step, she pondered whether it will be able to increase competition, increase accountability and quality, and at the same time, cut costs.
Public release of these types of quality data helps to make quality visible to patients and also provides physicians incentive to provide more high-quality care. “However, the evidence that publicly reporting quality information improves quality of care is mixed,” Werner wrote.
But she added, “Even if quality of care does not improve under public reporting, patients may nonetheless receive higher-quality care if they choose higher-quality providers; however, support for this is also mixed.”
The only way that public reporting will improve quality will be if the measures accurately reflect quality. However, Werner added that sometimes performance measures provide “inaccurate or misleading" information.
Including physician’s procedural volumes and complications rates could help improve care. Additionally, another problem may be the fact that the validity of outcome measurements depends on the adequacy of risk adjustment, she wrote. “If physicians do not believe that adjustment for severity of illness and other patient factors that influence outcomes is adequate, they might avoid patients [who] could reduce their measured performance,” she said.
Werner is also concerned that releasing these data could widen the gap between the have and have-nots in healthcare.
“Although this is desirable for patients who have access to higher-quality care, some patients served by safety-net providers unfortunately have limited choice and limited access to other providers,” she noted.
Despite those concerns, Werner said that releasing claims data is a major step for improving care.
“The response of patients and physicians to this newly available information will determine the success of the policy in the short term. In the long term, monitoring and understanding the responses will help shape further public reporting initiatives to foster meaningful improvements in healthcare,” she summed.
“On Dec. 5, 2011, the CMS announced that it will make its claims data available to rate healthcare providers on their quality of care,” wrote Rachel M. Werner, MD, PhD, of the Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, both in Philadelphia, in an ideas-and-opinions piece featured Feb. 13 in the Annals of Internal Medicine. “The goal of availing these data to the public is to enable consumers to make more informed choices about their healthcare providers.”
What will the rule entail? Qualified organizations such as consumer groups, employers and insurers will now have access to Medicare A, B and part D billing data. But only those who apply and are deemed appropriate in using such data to create performance reports will be allowed to view data.
“The qualified organization can then use these data to identify high-quality healthcare providers or create online tools to help consumers choose a provider,” wrote Werner.
Werner said that making these data available could be a “gamechanger” for healthcare due to the fact that Medicare covers more procedures, office visits and hospitalizations than any other entity. “Use of these data on healthcare interactions provides the opportunity to expand the quality and breadth of available performance measures,” she wrote.
But while Werner wrote that the release of these data may be an important step, she pondered whether it will be able to increase competition, increase accountability and quality, and at the same time, cut costs.
Public release of these types of quality data helps to make quality visible to patients and also provides physicians incentive to provide more high-quality care. “However, the evidence that publicly reporting quality information improves quality of care is mixed,” Werner wrote.
But she added, “Even if quality of care does not improve under public reporting, patients may nonetheless receive higher-quality care if they choose higher-quality providers; however, support for this is also mixed.”
The only way that public reporting will improve quality will be if the measures accurately reflect quality. However, Werner added that sometimes performance measures provide “inaccurate or misleading" information.
Including physician’s procedural volumes and complications rates could help improve care. Additionally, another problem may be the fact that the validity of outcome measurements depends on the adequacy of risk adjustment, she wrote. “If physicians do not believe that adjustment for severity of illness and other patient factors that influence outcomes is adequate, they might avoid patients [who] could reduce their measured performance,” she said.
Werner is also concerned that releasing these data could widen the gap between the have and have-nots in healthcare.
“Although this is desirable for patients who have access to higher-quality care, some patients served by safety-net providers unfortunately have limited choice and limited access to other providers,” she noted.
Despite those concerns, Werner said that releasing claims data is a major step for improving care.
“The response of patients and physicians to this newly available information will determine the success of the policy in the short term. In the long term, monitoring and understanding the responses will help shape further public reporting initiatives to foster meaningful improvements in healthcare,” she summed.