Medical specialty societies are pushing back on a CMS proposal that they believe will slow down MACRA's goal of improving cost, quality, and outcomes. "To get this [Medicare claims] data and match it to our clinical data is the golden egg," says one physician leader.
While hospital and physician group leaders focused on the broad implications of MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) at a U.S. House committee hearing Tuesday, medical societies are hoping Congress will pay more attention to a tiny section within the proposed rule that they believe could thwart the healthcare industry's ability improve healthcare quality and cost.
The Physician Clinical Registry Coalition (PCRC), a group of more than 20 medical specialty societies and other physician-led organizations, such as the American Academy of Neurology, Society of Thoracic Surgeons and American College of Emergency Physicians, contends that CMS isn't following the spirit of MACRA that grants access to Medicare claims data.
"We think CMS punted in a way that wasn't consistent with congressional intent," says Rob Portman, who coordinates and represents PCRC.
At issue is valuable Medicare claims data, which qualified clinical data registries were given access to in Section 105(b) of MACRA. Claims data is valuable to medical societies, such as the Society of Thoracic Surgeons (STS), because when it is combined with clinical data, physicians can measure patient care, cost, outcomes, and quality over time.
"STS collects robust clinical data up until the time of hospital discharge and 30 days after the operation, but Medicare data can tell us if someone's still alive five, 10, or 15 years after an operation," Jacobs says. "It can also tell us how many times they were admitted to the hospital, why, how much it cost, and what medications patients received."
In short, Jacobs says, the databases work best together. And, he says the issue isn't just about data.
"If the government wants to find ways to deliver more cost-effective health care, it would seem to be a no-brainer to allow unfettered access to Medicare data by societies," Jacobs says. "This doesn't just apply to heart surgery, it could apply to neurosurgery or psychiatry."
ResDAC vs. Medical Registries
As far as CMS is concerned, it is granting access to Medicare claims data. In a proposed rule released in February, CMS stated that registries, such as the one maintained by STS, could get Medicare claims data through the Research and Data Assistance Center, known as ResDAC.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.