(August 8, 2011) The Network for Regional Healthcare Improvement (NRHI) today urged the Centers for Medicare and Medicaid Services to significantly revise its proposed regulation governing release of Medicare claims data to ensure that Regional Health Improvement Collaboratives can obtain and use the data to measure and report on the quality and cost of healthcare in their communities. NRHI said that the requirements in the proposed regulation could either preclude participation of Regional Health Improvement Collaboratives entirely or make it extremely difficult for them to do so. “These requirements are inconsistent with what we believe was the intent of Congress – to ensure that Medicare claims data can be used by as many communities as possible to help improve the quality of care for Medicare beneficiaries and thereby to also help control costs in the Medicare program,” said Harold D. Miller, President and CEO of NRHI.
NRHI’s member Regional Health Improvement Collaboratives have the most extensive experience in the nation in successfully implementing performance measurement and public reporting efforts for a wide range of measures and for patients associated with multiple payers, and in ensuring the reports are used to actually improve the quality of care in a community. A number of NRHI members have been collecting and publicly disseminating measures of the quality of healthcare services in their communities for multiple years, and a growing number of members also measure and report on patient experience and the cost of care, but the ability of Regional Health Improvement Collaboratives to identify and address opportunities to improve quality and reduce cost has been impeded because claims data on the care delivered to Medicare beneficiaries have not been available. Consequently, NRHI members strongly supported Section 10332 of the Patient Protection and Affordable Care Act which authorizes release of Medicare claims data to organizations such as Regional Health Improvement Collaboratives, and last September, NRHI provided CMS with detailed recommendations on how to successfully implement Section 10332.
Many Regional Health Improvement Collaboratives intend to apply to become qualified entities under the provisions of Section 10332. Indeed, the Regulatory Impact Analysis in CMS’s proposed regulation to implement the law acknowledges that Regional Health Improvement Collaboratives will represent most of the organizations that can serve as Qualified Entities. In its comment letter, NRHI identifed a number of aspects of the proposed regulation that would impose unreasonable or unnecessary restrictions or burdens on Regional Health Improvement Collaboratives in obtaining Medicare claims data for quality measurement and reporting, and made recommendations for specific changes. For example:
- Under the proposed regulation, organizations would have to have three years of experience in handling and publicly reporting claims data from non-Medicare sources before they could obtain access to Medicare data. This is unnecessary, and could preclude many Collaboratives that are currently reporting from immediately obtaining Medicare data, and significant delay or preclude new Regional Health Improvement Collaboratives from beginning measurement and reporting programs.
- The proposed regulations would impose extensive and burdensome requirements on Collaboratives in order to apply to access the data. CMS estimates that 500 hours of effort could be required simply to submit an application. NRHI recommended that the application requirements be significantly simplified.
- Under the proposed requirements, Collaboratives would have to pay hundreds of thousands of dollars in administrative fees to obtain the data, most of which would be to cover CMS administrative costs to review the detailed applications it is requiring be submitted. NRHI urged that fees for release of data be limited to the direct cost of producing the data, particularly since Regional Health Improvement Collaboratives would be using the data to improve the quality of care for Medicare beneficiaries and reduce costs for the Medicare program.
- The proposed regulation would require that before a Collaborative can make any changes to the measures it uses, to the reporting format it uses for already-approved measures, or even to the method by which it shares approved reports with the public, it must submit the changes to CMS and wait for its approval before being able to proceed. NRHI said that requiring CMS review and approval of all changes in reporting formats and public dissemination strategies is an unnecessarily burdensome level of micromanagement that will be expensive for both CMS and Collaboratives and will severely impede the ability of Collaboratives to implement successful measurement and reporting programs.
- The proposed regulation would require that before any Collaborative could use Medicare data for a measure that had not been endorsed by the National Quality Forum, CMS would have to publish the proposed measure for notice and comment using the formal rulemaking process, an extremely expensive and time-consuming approach, even though the law does not require the use of a formal notice and comment process. NRHI recommended that CMS approve the use of an alternative measure in a community if the providers in the community supported the use of the measure.
- The proposed regulation would require that if the amount of claims data that a Collaborative is receiving from non-Medicare payers “decreases,” even by an insignificant amount, the Collaborative would have to immediately cease any measurement and reporting efforts using Medicare data until CMS “determines that the remaining claims data is sufficient.” NRHI urged CMS not to focus on the amount of data that a Collaborative has, but rather the Collaborative’s procedures for ensuring statistical validity of the measures.