Qualified organizations can develop doctor report cards starting next year after gaining access to Medicare’s claims database under a final rule.
Washington — The lack of a sufficient physician appeals process and other issues have physicians concerned about a new regulation that will allow the release of Medicare claims data for developing doctor quality scores starting in 2012.
On Dec. 5, the Centers for Medicare & Medicaid Services finalized a regulation granting access to physician billing data to qualified organizations, including consumer groups and employers. Doctors’ claims from 2009, 2010 and the first two quarters of 2011 will be available for analysis starting next year, according to the final rule
This is a giant step forward in making our health care system more transparent and promoting increased competition, accountability, quality and lower costs,” said acting CMS Administrator Marilyn Tavenner. “This provision of the health care law will ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar.”
To qualify, groups must show that they have experience evaluating performance measures, analyzing claims data and safeguarding information. Entities also are required to have access to claims data from other health payers, either private insurers or public payers such as Medicaid, to combine with the Medicare data.
The Medicare agency issued a proposed rule in June on the claims data release. The American Medical Association and 81 other physician organizations wrote a letter in August encouraging CMS to take steps ensuring that the data in performance reports are reliable. If done correctly, public reporting could help improve quality at the point of care, the organizations said.
But the final rule failed to create the mechanisms and safeguards needed to ensure that published information on doctors is correct, said AMA President Peter W. Carmel, MD. In some areas, restrictions on the data were relaxed. For instance, changes from the proposed rule would allow claims data to be distributed even if the accuracy of the information is in dispute and subject to an appeal. Dr. Carmel said this “is misleading to patients and does a disservice to physicians.”
“The AMA supports the use of accurate physician data when it improves quality of care for patients, but we are concerned that CMS’ easing of some requirements for receiving Medicare data could result in the distribution of physician performance reports that are inaccurate and not meaningful for patients or physicians,” he said.
Patient advocacy groups and employers have supported the release of physician billing data. Health coverage has become less affordable, and runaway health spending is adversely affecting other sectors of the economy, the Coalition for Affordable Health Coverage wrote in an August letter in support of data sharing. Improving public access to performance measures “will help facilitate incentives to provide higher-quality, lower-cost care,” the coalition stated.
Transparency is critical to making informed choices about doctors and medical services, the U.S. Chamber of Commerce said in its letter to CMS. “As purchasers of health care coverage and services, employers and individuals are eager to have access to more data on provider performance and quality to permit more informed health care decision-making.”
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