CMS clarifies quality measurement section of healthcare reform
The Centers for Medicare & Medicaid Services (CMS) issued a final rule regarding section 10332 of the Patient Protection and Affordable Care Act (PPACA), which allows for the release of Medicare claims data to qualified entities as a performance measurement tool, and specifically addresses the requirements organizations must meet in order to be considered a qualified entity.
According to the text of the final rule, section 10332 of the PPACA will allow researchers to standardize extracts of claims data under Medicare Parts A, B and D with data from other sources to analyze and publicly report on the performance of providers for the purpose of improving healthcare quality and reducing Medicare costs.
“We believe the sharing of Medicare data with qualified entities through this program and the resulting reports produced by qualified entities will be an important driver of improving quality and reducing costs in Medicare, as well as for the healthcare system in general.”
The final rule attempted to clarify the definition of a qualified entity, which is broadly defined as an organization that is, as determined by the U.S. Department of Health and Human Services (HHS) Secretary, able to perform analyses of claims data and to comply with laws regarding the security of data.
More specific requirements include a qualified entity’s ability to demonstrate at least three years of experience conducting performance measurements. A previous version of the rule demanded experience in four areas of measurement, quality, efficiency, effectiveness and resource use, but it was determined to be too restrictive.
Many organizations requested that the three years of experience requirement be removed, according to the text of the final rule, but the final rule stated that “many viable entities will possess three years of experience, particularly now that we have clarified that a qualified entity may contract with other entities in order to demonstrate required experience.”
Also, according to the final rule, for the implementation of section 10332 of the PPACA:
Section 10332 of the PPACA goes into effect Jan. 1, 2012.
The full text of the final rule is available here.
According to the text of the final rule, section 10332 of the PPACA will allow researchers to standardize extracts of claims data under Medicare Parts A, B and D with data from other sources to analyze and publicly report on the performance of providers for the purpose of improving healthcare quality and reducing Medicare costs.
“We believe the sharing of Medicare data with qualified entities through this program and the resulting reports produced by qualified entities will be an important driver of improving quality and reducing costs in Medicare, as well as for the healthcare system in general.”
The final rule attempted to clarify the definition of a qualified entity, which is broadly defined as an organization that is, as determined by the U.S. Department of Health and Human Services (HHS) Secretary, able to perform analyses of claims data and to comply with laws regarding the security of data.
More specific requirements include a qualified entity’s ability to demonstrate at least three years of experience conducting performance measurements. A previous version of the rule demanded experience in four areas of measurement, quality, efficiency, effectiveness and resource use, but it was determined to be too restrictive.
Many organizations requested that the three years of experience requirement be removed, according to the text of the final rule, but the final rule stated that “many viable entities will possess three years of experience, particularly now that we have clarified that a qualified entity may contract with other entities in order to demonstrate required experience.”
Also, according to the final rule, for the implementation of section 10332 of the PPACA:
- Healthcare organizations may request data from specific geographic areas for a fee in order to combine it with other claims data to analyze the performance of providers and suppliers and to generate public reports.
- Requests for data must be submitted in application form that includes a description of methodologies that the healthcare organization plans to use for analysis.
- Information on individual providers and suppliers contained in public reports must be presented in aggregate form, and must be submitted to the providers and suppliers in question to review before being made public.
- Claims data cannot be used for purposes other than generating public performance reports, such as internal analyses, but there are no restrictions on the use of publically reported results.
Section 10332 of the PPACA goes into effect Jan. 1, 2012.
The full text of the final rule is available here.