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Groups Object to CMS Quality Reports Plan

Margaret Dick Tocknell, for HealthLeaders Media, August 8, 2011

Inland Northwest Health Services, a Spokane-based nonprofit that provides information technology and quality measurement services to rural healthcare providers, said some of the rule requirements would limit participation by rural healthcare organizations. “Historically rural regions have been served primarily by the two government payment programs, Medicare and Medicaid, and a very limited number of private payers. Those private payers have been reluctant to share claims information as it could reveal too much about their cost and payment models. By limiting participation in this new program to organizations that have extensive multi-payer experience, CMS will essentially be disenfranchising rural healthcare providers and the organizations that serve them. To address this issue, we strongly recommend that CMS allow organizations with experience in rural healthcare systems to participate by partnering or contracting with others that have more experience in claims data. This approach will ensure that rural healthcare organizations will have affordable access to this new information while also assuring that CMS’ methodological concerns are addressed.”

The National Business Group on Health, which represents 330 large employers who provide healthcare benefits for 50 million employees, retirees and dependents, said that despite the rule’s good intentions it “goes against the congressional intent and spirit of the law by unnecessarily narrowing consumers’ access to the data and limiting the ability of organizations to conduct innovative analyses of the data to improve consumer choice and providers’ performance.”

Noting that the proposed rule “restricts the release of Medicare claims data to qualified entities that agree to release their evaluations of providers’ performance to the public,” the business group asked CMS to “consider alternative access for employer-sponsored plans that want to use the data for internal purposes only (provider network contracting, pay-for-performance, value-based benefit design, value-based purchasing), with less stringent requirements than for qualified entities since they will not publicly report this information.”


Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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