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How Does Your Provider Measure Up? “Report Cards” Ranking Provider and Supplier Performance Coming Soon

Earlier this week, the Centers for Medicare and Medicaid Services released a proposed rule that would make Medicare information regarding provider cost and quality available to certain organizations. The non-identifying claims data would be used to produce public reporting on physicians, hospitals and other healthcare providers to enable consumers and employers to select higher-quality, lower-cost physicians. The Medicare data would be combined with claims data from the private sector and allow consumers and employers to determine which providers and facilities provide the highest-quality at the lowest cost.

The rules include provisions to protect the data. Only entities that have the ability to process the data accurately and combine it with private sector claims records are eligible to receive the information. CMS envisions the end result will be quality reports that are representative of overall provider performance. By releasing this data, CMS hopes to offer employers, consumers and even providers themselves with a complete, rather than partial picture of quality performance. The combination of Medicare with private sector data will hopefully offer a more comprehensive picture of a providers overall performance, and not just pinpoint a subset of his/her patient population.

In the rule, CMS proposes to provide extracts from Medicare Parts A, B and D claims data to qualified entities only if they already have claims data from other sources available. Qualified entities would be required to publicly report their results and would need to share with providers and suppliers prior to release to ensure the accuracy of data and accept any corrections. CMS believes that this initiative, combined with other quality programs such as Hospital Value-Based Purchasing, will lead to more informed and engaged consumers.

We applaud CMS for their decision to make this data available to certain entities. We’ve been long-time fans of the Dartmouth Atlas of Health Care, a tool used to evaluate the efficiency and effectiveness of how medical resources are distributed and used in the United States. The Atlas has pointed out geographic differences in national, regional and local markets and has been used to improve the understanding of how healthcare is consumed and delivered in our country. Unlike the new proposed rule, the data in the Dartmouth Atlas only contains Medicare data. We believe that if analyzed and incorporated correctly, this proposed rule has the potential to take what The Dartmouth Atlas has been doing for the last twenty years to a whole new level.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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