Availability of Medicare Data for Performance Measurement Final Rule
On December 5, the Centers for Medicare and Medicaid Services (CMS) published its final rule regarding the “Availability of Medicare Data for Performance Measurement.” The Affordable Care Act (ACA) authorizes the release of standardized extracts of Medicare claims data under parts A, B, and D to “qualified entities” for the performance evaluation of providers and suppliers. These entities will then make performance reports publically available. This data will be provided to qualified entities beginning January 1, 2012. Qualified entities approved at the beginning of the program will be provided with calendar-year data for 2009 and 2010, and from the first two quarters of 2011. Thereafter, CMS will provide quarterly data updates on a rolling basis.
The final rule is very detailed and complex, and we are continuing to analyze it to better determine the impact on physicians. We are preparing an in-depth comparison of the provisions in the final rule and our AMA position.
During the drafting of the legislation in the ACA, AMA secured a number of safeguards in the ACA provisions, including requirements that enable physicians to review, appeal, and correct errors in the reports prior to publication. On August 8, 2011, AMA coordinated a comment letter with 81 physician organizations to CMS responding to the proposed rule and urging the agency to carefully develop a final rule in which qualified entities: (i) meet each of the requirements we secured in the data release provision, as set forth in the ACA; (ii) produce public reports that are valid, meaningful, actionable, and user-friendly; and (iii) participate in a reporting program that is standardized and streamlined to minimize administrative burden and allow comparable results. The letter acknowledged CMS’ efforts to implement the safeguards outlined in the ACA data release provision, but also expressed the need for the agency to move toward standardization of many elements qualified entities will use in developing and releasing public quality performance reports, e.g., measure specifications, risk-adjustment, and attribution methodologies.
AMA supports the use of physician data when it improves the quality of patient care, promotes the efficient use of resources in care delivery, preserves access to care, and provides accurate physician performance assessments. In the final rule, however, CMS has eased some of the proposed requirements a qualified entity must to meet to receive Medicare data. This may benefit highly qualified research efforts, but also poses greater risk of public release of poorly analyzed data. Although AMA aggressively urged CMS to begin moving toward standardizing elements qualified entities will use in developing and releasing public reports, CMS has made no move in this direction in the final rule. These factors increase the risk of multiple entities obtaining Medicare data in a single geographic area, and each of these entities could use different methodologies in analyzing the data, thereby resulting in a proliferation of physician performance reports that are conflicting, inaccurate, and not meaningful for patients and physicians. We do not yet know how serious this problem will be, as this will depend on implementation of the program. AMA will aggressively work to urge the Administration to monitor the program and to modify it if qualified entities release misleading or confusing performance reports.
We also believe CMS should strengthen the appeals process for physicians requesting error correction in a public report. CMS has maintained in the final rule the proposal that qualified entities must publically release performance reports, regardless of whether there are outstanding, unresolved physician appeals. AMA advocates that a qualified entity should only display the provider’s name and indicate that the results are still pending in the event of an ongoing appeal. We also believe CMS or an independent third party should assist in settling unresolved appeals.