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Ardis D. Hoven, M.D. Headshot

Leveraging Medicare Data to Improve Care

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Earlier this month, the administration published Medicare physician claims data in response to calls for greater transparency. However, due to its non-user-friendly format, lack of contextual information, and serious limitations, it is impossible to use the data to draw useful conclusions to improve the quality of care. There was certainly a lot of effort put around the release of the data; but wouldn't it have been a better use of time and resources to provide actionable data that would actually have a positive impact on care delivery in this country?

Having accurate and timely utilization, cost and outcomes data would allow the physician community to expand the use of new health care delivery and payment models that so many policymakers and thought leaders say are needed. In order to improve health care, physicians need to be able to look at outcomes, identify shortcomings in practice processes and see where costs can be better managed in real time.

For several years, the American Medical Association (AMA) has advocated for accurate utilization data from the Centers for Medicare and Medicaid Services (CMS) be provided to physicians in a timely manner so they can evaluate care choices, reduce costs and improve quality. Just last month the issue was addressed in the bipartisan, bicameral Sustainable Growth Rate (SGR) repeal legislation that Congress failed to pass. The original SGR bill, which was supported by the physician community, would have required CMS to provide physicians with data on items and services provided to their patients by other Medicare providers. It would have also provided insight into everything covered by Medicare as well as analysis of averages and distribution of services, both current and historical, which could have alerted physicians to changes needed in their practices as well as inform referral choices.

If the bill were enacted, physicians would have been able to see the full picture of patient health and patient care. It would have been possible for them to improve the value of health care services through better coordination to keep patients healthy, and strengthen the physician-patient relationship by providing more background information and accurate information on outcomes to help them make more informed health care decisions.

The coordination facilitated by timely quality and utilization data would encourage physicians to explore new payment models. Physicians would be more drawn to accepting bundled payments in multi-specialty group practices and to participate in Accountable Care Organizations where clinicians work together to manage care from start to finish and are incentivized to use preventive care techniques to keep patients healthy. Both models are supported by the Affordable Care Act. Patients are expecting those types of innovative changes, but without quality and utilization data, it is difficult to make them.

Right now, physicians can't easily track the results of the full scope of care patients receive in real-time or learn other important information about their patients' care outside the individual physician's practice. For example, if physicians had better and timely information about their patients' hospital admissions, they could work to implement practice changes that would improve coordination and follow-up for these patients, reduce fragmentation and readmissions and improve outcomes. Additionally, if physicians had easy access to information about medical tests their patients' already received, it would reduce unnecessary or inappropriate testing -- saving patients time, reducing their level of discomfort and cutting costs.

There is no question that more data transparency could be useful in improving quality, increasing value and helping patients make decisions about their care. CMS needs more resources to refine its quality and utilization reports and give physicians real-time and pertinent information that they can use to improve care delivery as well as make judicious use of Medicare dollars.