Managed-care plans contracting with Medicare will be required to undertake their first widespread quality reporting effort beginning Jan. 1, 1997, a HCFA official announced last week.
HCFA will require the plans to furnish the Medicare-relevant portions of version 3.0 of the Health Plan Employer Data and Information Set, or HEDIS, said Bruce Fried, director of the HCFA Office of Managed Care. HEDIS is the program of self-report-ed quality measures created by the National Committee for Quality Assurance.
Each of the approximately 250 plans also must participate in an extensive beneficiary survey.
"This will change in very profound ways the terms of competition in the Medicare sector," Fried said.
Federal officials are concerned about how the information would be released to the public, Fried said. HCFA stopped releasing hospital mortality data in 1993 after hospitals complained that the data offered an incomplete and often inaccurate picture of hospital quality.
"I want to make sure we don't repeat the hospital mortality report debacle," Fried said. "The road to hell is certainly paved with good intentions, and we got a pretty far way down that road with hospital mortality data."
Fried and other HCFA officials met in Baltimore Sept. 6 with representatives from more than 100 managed-care plans, consumer groups and trade associations to detail their plans.
A spokesman for the American Association of Health Plans said his group supported the HCFA initiative but was concerned that plans may not be able to meet the Jan. 1 start-up date.
"We are four-square behind performance measures and have committed to discussing with HCFA a reasonable implementation schedule," said AAHP spokesman Donald White. "This will be a challenge. Plans will have to make two times to three times the expenditures they now have to make to gather the new data."
Earlier this year the AAHP said it supported HEDIS 3.0 and called on all health plans, including fee-for-service systems, to provide the same data.
"We believe all healthcare professionals should be held accountable for the quality of the services they provide," said AAHP President Karen Ignagni.