Department stores aren't the only ones slashing prices for the holidays. The CMS seemed to be listening to concerns from the field about high costs when it unveiled the final version of a rule that makes its Medicare claims data accessible to selected regional quality organizations.
CMS drops cost of claims data in final rule
Such groups had long lamented the lack of available data on the quality and cost of care for older Americans, but the projected price tag included in the proposed rule—roughly $200,000 for three years of data on 2.5 million Medicare beneficiaries—was far too high for the lean, not-for-profit organizations most interested in the information, they said.
In the final rule, released Dec. 5, the CMS lowered the projected fee by 80%, to about $40,000 for three years of data.
“We are very pleased,” said David Hopkins, a senior adviser with the Pacific Business Group on Health, a San Francisco-based business coalition. “Consumers need better information about the quality of care provided by physicians, and you need a lot of patient data to reliably measure performance. That's what this gives us.”
Mandated by the healthcare reform law, the rule requires the CMS to provide extracts of administrative claims data to qualified entities for use in gauging provider performance in their regions. The agency says it expects about 35 applicants for approximately 25 spots open for eligible organizations. The rule will take effect in January, and the CMS will accept applications on a rolling basis with no deadline.
The CMS came up with the original $200,000 price listed in the proposed rule, announced June 3, by calculating the cost of processing applications, creating customized data sets, monitoring qualified entities and ensuring secure data transmission. But they backed off from that total after many regional quality groups said the cost would likely prevent them from participating.
The groups also argued that the quality reports and tools that they would produce with Medicare's data would serve a public good.
In response, the CMS omitted the program management fees from the total cost, bringing the fee for each entity down to about $40,000.
“CMS concurs that there are public interests at stake that justify narrowing the scope of what constitutes the cost of making this data available,” the agency said in the final rule.
In a news release, CMS Acting Administrator Marilyn Tavenner called the rule a “giant step forward” for transparency, competition and accountability. “This provision of the healthcare law will ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar,” she said.
Jim Chase, president of Minneapolis-based Minnesota Community Measurement, applauded the price reduction, adding that his organization will probably apply for the program.
“Most of us are very small non-profits,” he said, referring to regional improvement organizations, “and we kind of had to laugh when the proposed rule came out. But now it's within our reach.”
The reduced cost isn't the only welcome change in the final version, said Harold Miller, president and CEO of the Network for Regional Healthcare Improvement, Pittsburgh, a membership association for regional healthcare improvement collaboratives. In August, NRHI submitted extensive comments on the proposed rule, Miller said.
“We were very pleased because the final rule incorporates almost all of the changes that we recommended,” he said.
Among those changes was a provision that allows organizations to apply at any point during the year, giving much more flexibility than the proposed March 31 deadline, Miller said. The CMS will also provide data to participating organizations on a quarterly instead of yearly basis. And the final rule also allows qualified entities to use a new measure if it is scientifically sound and meets the needs of their local population, a provision that NRHI had pushed for, he said.
“If a measure makes sense in your market and local stakeholders support it, you don't have to go through a long notice-and-comment period,” Miller explained. “That is one opportunity to get some real innovation.”
The CMS also said it will provide qualified entities with a crosswalk file of Medicare beneficiary data with patient identifiers, enabling participating organizations to connect patient-level clinical data with claims data and give local physicians more detailed feedback on their performance.
The crosswalk provides another level of accuracy and specificity, said Mylia Christensen, executive director of Oregon Health Care Quality Corp., Portland, adding that her organization plans to apply to become a qualified entity.
There were some changes that NRHI had hoped for that did not make it into the final rule, Miller said. For instance, the CMS kept a provision requiring qualified entities to re-apply every three years, instead of allowing approval to extend indefinitely, as NRHI had suggested.
But the few gripes are minor, especially because so many of NRHI's larger concerns were addressed, Miller said.
“They made so many things better,” he said. “They did great work and they made the program much more feasible and useful.”
The agency's flexibility in this instance could signal a willingness to work with regional quality organizations on other projects, Christensen said.
“CMS recognized the strength and experience of regional healthcare collaboratives, and that is very significant,” she said. “I think it bodes well for future collaborative opportunities, especially with the large innovation grants that are coming soon.”
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