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Doctor Groups Seek Changes To CMS Disclcosure Rule

Proposed rule on the use of Medicare claims data to measure clinicians' performance would burden doctors and healthcare IT staff, the AMA and others say.
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Concerned about administrative overload and misrepresentation, several physician organizations are recommending changes to the Centers for Medicare and Medicaid Services’ (CMS), proposed rule to implement new statutory requirements that govern the release and use of relevant Medicare claims data to measure clinicians' performance.

The collection of Medicare claims data for the purpose of providing reports that measure performance and quality of care will have significant implications for IT departments and physicians who will have to take the time to extract the data, format it, and present the information to qualified entities that will be charged with preparing the reports.

Earlier this month the American Medical Association (AMA) and 81 physician organizations sent a letter to CMS administrator, Donald Berwick, urging the agency to standardize the process for developing public reports and the type of information they will include, not only across the Medicare system but for private insurance data as well.

To reduce the administrative burden, the AMA is recommending that "CMS move toward standardization of many elements qualified entities will use in developing and releasing public reports." That standardization address "measure specifications; the content of public reports; formatting of the reports; risk-adjustment and attribution methodologies; and appeal processes."

The AMA also urged CMS to ensure that physicians are allowed to review their data for accuracy and to appeal any errors before their information is made public.

According to Bob Jasak, assistant director, Regulatory Affairs and Quality Improvement Programs at the American College of Surgeons, the ability of physicians to review and update information has wide implications both for hospitals and physicians.

"We are troubled by the potential for inaccurate information to be out in the public," Jasak told InformationWeek Healthcare. "That could affect the reputation of surgeons and other physicians and can lead to false or just not useful information that patients may choose to act on."

In their letters to Berwick, both the Surgical Quality Alliance, and the American College of Cardiology (ACC) recommended that CMS add clinical data as part of the reporting program.

"ACC opposes the proposal to limit qualified entities to only using claims data to calculate performance measures. Instead, we believe that CMS should encourage the qualified entities that purchase the Medicare claims to work with organizations that have access to large amounts of clinical data from registries. This clinical information would add a great deal of context to these claims data," the ACC wrote.

To improve the accuracy of reporting on outcomes, Jasak gave the example of reporting on gall bladder surgeries at a hospital.

"For this type of surgery, the number of outcomes of recovery, or whether patients are readmitted to a hospital can vary significantly based on whether patients have other chronic conditions," Jasak said. "It's really hard to get an accurate picture of health outcomes when you're just looking at administrative data."

Unfortunately adding clinical information will also increase the volume of data needed for accurate reporting. While the consensus is that collecting, reviewing and revising performance reports will have an impact on medical IT departments as well as physicians, the cost of performing such tasks is in dispute.

For example, in its proposed rule CMS estimates the total hourly cost that physician’s offices will have to spend to engage in reviewing and appealing performance reports is $41.10, a figure that underestimates the costs, according to AMA.

"Although certain administrative tasks, such as pulling patient records, may be performed by non-physician office staff, much of the work of reviewing and appealing reports will involve a physician's own time, for which an hourly rate of $41.10 represents a major undervaluation of physician labor," the AMA wrote.

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)