As mandated by the Patient Protection and Affordable Care Act (ACA), CMS would provide standardized extracts of claims data from Medicare Parts A, B and D to the qualified entities. Those entities would be required to combine the Medicare data with claims data from other sources in producing evaluations. The entities also would be required to pay a fee to cover the cost of making the data available.
The organizations called on CMS to consult with physicians and other stakeholders to standardize the data used, as well as the content and formatting of the reports.
Key points in the letter include:
- Develop a final rule that would produce public reports that are valid, meaningful, actionable, and user-friendly
- Standardize for all payers, including Medicare and private payers, the descriptions required for Medicare and private payer data and the methodologies used by qualified entities
- Provide specifications that qualified entities must meet in applying strong, effective, and adequate risk adjustment and attribution techniques, and test and adjust these techniques before reports are made public
- Ensure that the quality performance determinations presented in the reports avoid conflicting reports with different conclusions due to a lack of applying accurate, transparent and consistent risk-adjustment and attribution methods
- Establish a rigorous process for proving that “alternative” measures meet the statutory threshold
- Create a review and appeals process to allow physicians or other providers/suppliers to have an opportunity to appeal and correct errors before the report is goes public
Click here to read the letter on “Availability of Medicare Data for Performance Measurement.”