Based on Law in the Affordable Care Act Backed by Udall and Bennet to Give Patients More Access to Data on the Quality of Health Care Providers
Announcement Comes Following Udall-Bennet Letter to HHS Urging Consumer-Friendly Swift Final Rule to Provide Data
New Ruling Will Help Colorado-Based HealthGrades Provide Information for Patients
Colorado U.S. Senators Mark Udall and Michael Bennet applauded the decision on the release of Medicare data by the Centers for Medicare and Medicaid Services (CMS) at the Department of Health and Human Services (HHS) that will allow for the use of this information to measure the performance of health care providers and suppliers while protecting patient privacy.
Following a formal rule making process, CMS has issued a final rule that is based on a law Udall and Bennet threw their support behind in the Affordable Care Act to provide transparency to businesses and consumers and more information for patients to make informed decisions about where and from whom to receive care.
“Armed with this new information, Colorado families and businesses will be better equipped to choose the best possible health care providers for their needs, while being assured their private information remains private,” said Bennet. “I’m glad CMS has followed through on this important element of the Affordable Care Act that will improve quality and transparency in the health care sector.”
“Ensuring patients have better access to information about doctors and hospitals will empower them to make better informed decisions about their health,” Udall said. “Increasing transparency in the health care system will also encourage health care providers to be more consumer-focused, to prioritize quality service for Americans, and help reduce health care costs overall.”
Specifically, this rule explains how organizations can qualify to receive certain claims data relating to Medicare Parts A, B, and D in order to evaluate the performance of health care providers of services and suppliers. Approved organizations can transform this data into information that patients can easily digest to inform their decisions when making choices about their health care.
For example, HealthGrades, a Colorado-based company, has used limited data currently at its disposal to measure hospital performance, and it has made that data available nationally to patients for 13 years. HealthGrades would now be able to access, among other data, information on the quality outcomes of physicians and other health care providers to help patients assess what doctor is best for their specific needs.
Earlier this year, Udall and Bennet joined Senator Mark Warner (D-VA) in sending a letter to CMS Administrator Donald M. Berwick urging CMS in its final ruling to strike the right balance of ensuring a variety of appropriate organizations across the health care spectrum are able to make sense of the large amount of data being collected by CMS in a way that empowers consumers, while still ensuring that these organizations have the expertise to generate accurate measurement and protect the privacy of patients.
The full text of the letter is included below.
Dear Dr. Berwick:
It is no small task to transform our health care system into one that drives higher quality outcomes while lowering costs, and we applaud you and your team at the Centers for Medicare and Medicaid Services (CMS) for your commitment to successfully implementing the Affordable Care Act. Greater transparency in the health care sector, including more expansive and publicly available performance measures, are key to this effort. We write to provide several comments, which we hope will be helpful, as CMS continues assembling a final regulation regarding the availability of Medicare data for performance measurement (Section 10332 of P.L. 111-148).
In drafting this particular section of the law, Congress’ objectives included both 1) the thoughtful utilization of existing data to improve patient care and reduce costs to Medicare, and 2) better information for consumers to help them choose health care providers that provide the best care possible for their needs. To achieve these objectives, it is important that CMS strikes the right balance of ensuring a variety of appropriate organizations across the health care spectrum are able to make sense of the large amount of data being collected by CMS in a way that empowers consumers, while still ensuring that these organizations have the expertise to generate accurate measurement. In addition, it is important that CMS maintain robust privacy parameters to protect patients.
Due to the immense scope of the task at hand, and the very specialized skills, resources, and capacity needed to comply with the important privacy, data integrity, and performance measurement criteria, we encourage you to allow qualified entities to partner with other organizations in order to bolster their ability to comply with program guidelines. For example, by allowing qualified entities to license their performance reports to experts in the field of performance measurement, we believe it will be easier for these entities to build data reporting business models that can be successful, consumer-friendly, and true to the law. Qualified entities should then be given clear direction regarding their ability to license performance reports or partner in similar ways with outside experts and we encourage CMS to provide this information in the final rule.
Additionally, we support your efforts to engage stakeholders in exploring the option of allowing qualified entities to work with nationwide Medicare data in order to generate performance measurement. Such an option would allow for quality and performance to be compared across the nation in addition to locally and regionally. Expanding the scope of comparison will allow consumers to see a broader picture of quality and performance in the health care system, consistent with a national strategy for improving outcomes and lowering costs.
Finally, we also urge you to maintain a thorough and fair appeals process for health care providers and suppliers as you finalize this regulation, including the ability to obtain performance reports related to their provision of care and business practices prior to such reports being released to the public. If we are going to allow experts in performance measurement to evaluate Medicare and other claims data, it is of utmost importance that we give the relevant providers and suppliers the ability to appeal and correct any errors that might be made in such reports prior to their public release.
Section 10332 of the Affordable Care Act provides us a unique opportunity to further the goals of quality improvement and transparency, while giving patients better tools to be smart consumers of the health care system. We appreciate your consideration of our comments as you continue in this effort.