December 1, 2012
Last week, the Centers for Medicare and Medicaid Services (CMS) announced the launch of the Medicare Data Sharing for Performance Measurement program (see Medicare Continues Effort To Give Consumers More Information On Health Care Quality). The quick summary – CMS is planning to combine Medicare claims data with data from other payers to provide publically-available reports on provider performance.
CMS plans to select independent organizations, referred to as “Qualified Entities”, to compile these provider ratings using de-identified Medicare claims data under parts A, B, and D combined with private payer data – with a focus on 459 standard performance measures mandated by CMS. The measures are a combination of National Quality Forum-endorsed measures and the Hospital Inpatient Quality Reporting (IQR) measure set. In January 2012, NQF provided CMS with a list of 443 endorsed measures that use administrative claims data, as well as measures that incorporate clinical data with administrative claims data (see List of National Quality Forum Standard Measures under the Qualified Entity Certification Program ). The 59 HIQR Measures were published in August, 2011 and include 25 claims-based measures (see List of Hospital Inpatient Quality Reporting (IQR) Measure Set under the Qualified Entity Certification Program ). CMS plans to update this measurement list on a quarterly basis. For more detailed information, check out the final rule .
CMS has selected the first three Qualified Entities – the Health Improvement Collaborative of Greater Cincinnati; Kansas City Quality Improvement Consortium; and Oregon Health Care Quality Corporation. CMS expects these organizations to produce the performance reports within 12-months of receiving certification and the Medicare data sets. So for the three organizations that were selected this month, we should expect to see the first reports by the third quarter of 2013.
What does this mean if you are part of a service delivery organization? It’s really more of the same. This program is just one of many recent initiatives introduced by CMS to enhance performance throughout the health care system – such as the Hospital Value-Based Purchasing program , the Shared-Savings Program , and the Medicare Hospital Readmissions Reduction Program . Managers of service delivery organizations need to get in front of this trend toward transparent performance data. There are three management keys: develop the ability to report performance data quickly and inexpensively, track that data before it is in the public domain, and manage performance using metrics-based management approaches. The management teams with these competencies are the management teams with competitive advantage.
Monica E. Oss
Chief Executive Officer, OPEN MINDS
For another free resource, see: Performance Measures For the Chronic Complex Population all members
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