Demand grows for transparent quality measures


The health-quality measurement bandwagon is picking up steam these days as both public and private payers struggle to deal with rising costs and the need to ensure quality care. Medicare has greatly enhanced its "Hospital Compare" Web site by posting the results of a patient survey on satisfaction with care during hospital stays.

In the private sector, doctors have agreed to collaborate with insurers and other payers to develop uniform standards for rating physician quality of care (See News Analysis). Medical providers evidently decided it's better to have a say in the design of a more transparent rating system than to watch the proliferation of diverse insurer and payer performance rating initiatives.


Last year, CMS added MA plan quality ratings to its Medicare Options Compare (MOC) Web site to help bene ciaries weigh coverage choices. The system now gives star ratings to plans based on price combined with HEDIS (Healthcare Effectiveness Data and Information Set) information reported to NCQA.

CMS also has expanded MA reporting by collecting some HEDIS data from Medicare preferred provider organizations. The PPOdata is limited to administrative measures, however, because these plans have diffculty obtaining information from patient medical records.

Next year, CMS will add utilization data to MA plan measurement, notes Abby Block, director of CMS’ Center for Beneficiary Choices, at a recent conference on MA quality measurement. In debating whether MA payments are too high, Congress wants to know if these plans use rebates to provide important extra benefits.

"We know what's being offered," Block says, "but not what beneficiaries are actually using."

CMS also will start collecting quality reports from Special Needs Plans (SNPs) this year, initially from about half of nearly 800 SNPs that serve low-income, disabled and nursing homes patients. A three-year rollout of the program will begin with reports on a limited set of HEDIS measures. The aim is to determine if SNPs provide "more meaningful health service choices," Block explains, a goal that has been questioned by some members of Congress.

One hole in MA quality assessment is that private fee-for-service plans do not have to report any quality data, said NCQA President Margaret O'Kane at the conference. CMS is asking larger private fee-for-service plans to submit some HEDIS data voluntarily. But the "growth in unaccountable private fee-for-service plans is troubling," says O'Kane, particularly because their reimbursement is set at a higher rate than other MA plans.

CMS also plans to survey consumers on whether Medicare quality and performance data is helpful.

"We can develop all the measures in the world, but if they're not being used by consumers, we have not achieved our goal." Block says.

Jill Wechsler, a veteran reporter, has been covering Capitol Hill since 1994.

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