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Groups Object to CMS Quality Reports Plan

 |  By Margaret@example.com  
   August 08, 2011

A rule proposed by the Centers for Medicare & Medicaid Services to allow Medicare and private sector claims data to be used to produce public reports that evaluate the performance of physicians and other healthcare providers raised a number of red flags among the 40 public comments submitted so far. The comment period ends tonight, Aug. 8, at 11:59 p.m.

Among the concerns: the criteria for the qualified entities that will compile the data, the ability of providers to contest the produced reports, and privacy. The comments filed were primarily individual physicians and specialty groups such as the American Association of Orthopaedic Surgeons. Some business groups, including the Business Roundtable and the National Business Group on Health, also filed comments on the proposed rule, Medicare Program: Availability of Medicare Data for Performance Measurement, docket ID CMS-2011-0122.

The rule is an effort to standardize quality measurement in a way that influences providers to improve the standard of care they deliver. Although the comments reflect general support for quality measures, with only a few exceptions the statements are focused on the mechanics of process and not whether the rule will improve care.

Here’s a sampling of the comments posted on regulations.gov:

Anonymous from Texas said: “This proposed rule will drive physicians to a race to the bottom by providing the least costly, but not necessarily the most innovative treatment for their patients.”

Robert Rubino, who is identified only as being from New Jersey, expressed doubt that an agency the size of CMS can react with any speed to new technologies and protocols that may improve the quality of care delivered. “The premise that a government entity that is so poorly run, such as Medicare and Medicaid, can assess quality of care is ludicrous. By the time Medicare recognizes new technology as a standard of care it is often already obsolete. Physicians constantly hone and perfect their care based on peer reviewed journals, shedding old protocols while adopting new ones. The slothful behemoth of CMS could never keep up with them. To simply apply a change in a treatment paradigm on the CMS side would take months or years for it to filter through the bureaucracy.”

Charles Groves, a physician in Indiana, suggested that the rule might mean he could no longer serve some patients. “If I am going to be evaluated by the expense of lab/x-ray/hospitalization costs, then I will need to fire patients with expensive, chronic medical problems.”

The American Association of Orthopaedic Surgeons, which represents more than 18,000 orthopedic surgeons, asked that the experience requirements be strengthened for organizations interested in accessing the Medicare data. “The AAOS believes that qualified entities should have a minimum of five years experience in performance metrics and prior use of Medicare or other payer claims data, not the currently proposed three years. We also believe that organizations should have a concrete plan to furnish data to providers and patients that is reliable, accurate, and actionable.”

In addition, AAOS recommended that providers be given 60 to 90 days to review any reports before they are made public. “We also urge CMS to require qualified entities to supply providers with a more granular report that is easily obtained and can actually be reviewed for discrepancies.”

The American Psychiatric Association, which represents more than 37,000 psychiatric physicians, cited the need to punish any organization that violates patient privacy. “The APA endorses requiring approved qualified entities to execute a data use agreement before receiving any CMS data. Where qualified entities misuse or leak a Medicare beneficiary’s identifiable healthcare data, the APA asks for immediate termination of the qualified entity’s access to any CMS data, followed by the imposition of civil monetary and criminal penalties, as well as provider notification of the breach.”

In its comments The American Chiropractic Association expressed concern about the quality reporting data being captured by CMS for doctors of chiropractic. “Because there is only one service provided by doctors of chiropractic that is covered by Medicare DCs are extremely limited in the quality measures for which they can report. Although DCs are licensed and trained to provide evaluation and management services, radiologic and diagnostic service, physical medicine and rehabilitation services and other procedures, DCs cannot report on any quality measures related to the provision of those services. Now that that PQRS quality measures will be the basis for the reports disseminated by qualifying organizations, the data for DCs will be extremely limited. When compared to private insurers there will be no comparable Medicare data for the services that DCs provide, aside from spinal manipulation.”

The American College of Cardiologists, a40,000-member nonprofit medical society, commented that physicians are not allotted sufficient time to review and comment on the data released. “While physicians are given an opportunity to review the data, CMS only proposes as little as a 10-day period in which to review what may be thousands of records covering a period of two to three years.

This is not nearly enough time to review data and point out errors to the qualified entities. In addition, the rule is unclear on what happens if a physician or other provider does identify problems. The ACC urges CMS to provide a longer period for physicians and other providers to review data and a specific action plan for the qualified entities if a physician or other provider identifies an issue.”

The American Academy of Neurology, which represents 24,000 neurologists and neuroscience professionals, requested that CMS “specify requirements surrounding whom physicians can be compared to and rated against. For example, QEs should compare physicians in their reports matched by how often they work full or part?time, whether they practice in an urban or rural environment, the severity of the patients they treat, and what part of the country they practice in (the state or metropolitan statistical area).”

The Business Roundtable, an association of CEOs representing more than 35 million employees, retirees and dependents, asked CMS to provide an option so that qualified entities with less than three years of experience in performance metrics could be included in the program if they have “sufficient experience in other related areas.”

The group supports limiting the correction and appeals process to 30 days. “We certainly agree that providers must have the opportunity to identify and correct errors in the report prepared by the QE. Indeed, inaccurate data can cause harm. By the same token, however, the correction and appeals process should also not become an open-ended process that may inadvertently create incentives or opportunities for certain providers to use these procedures to block or delay issuance of an accurate report that shows marginal or poor performance by the provider.”

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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