CMS announces first report on provider performance from a Qualified Entity

Niall Brennan, Acting Director, CMS Offices for Enterprise Management

Data can play an integral role in helping consumers decide on everything from which car to drive to choosing a hotel. Indeed, data-driven decision support tools are available in almost every sector. Though many tools are available in health care, the sector as a whole has lagged behind others in providing data on health care quality and cost.

Today, we are excited to announce the first public report on provider performance and cost facilitated by the Medicare Data Sharing for Performance Measurement Program, known as the Qualified Entity Program. The Qualified Entity Program allows organizations that are certified as qualified entities (QEs) to combine Medicare claims data from the Centers for Medicare & Medicaid Services (CMS) with claims data from other payers to evaluate the performance of health care providers and suppliers. QEs must protect the privacy and security of the Medicare claims data and may use it only for purposes of the QE Program. While community-based groups across the United States have been working for two decades to better understand the quality and cost of health care within their communities, many of their efforts have focused on combining claims data from private payers within the community and sometimes from Medicaid programs. For the first time, organizations are able to analyze Medicare claims data alongside claims data from private payers and Medicaid. These new reports from QEs include care provided to the elderly and disabled population (a population with the greatest health care needs).

The first public report using Medicare data comes from the Oregon Health Care Quality Corporation (Q-Corp), an organization that produces data and analytics about the quality and utilization of health care in Oregon. Q-Corp was one of the first entities to be certified for Medicare data sharing. The addition of Medicare data has allowed Q-Corp to offer providers and consumers more complete information about the quality of care across the state of Oregon. The Medicare data has also allowed Q-Corp to publish quality measures for clinics that did not have a large enough patient population for reporting using only commercial and Medicaid data.

Today’s announcement is the latest of several efforts that demonstrate this Administration’s commitment to making health care performance and cost more transparent. As the single largest payer for health care in America, the CMS generates billions of data points each year. For decades, CMS has been an innovator in the use of this data.

Earlier this year, CMS released data on the services and procedures provided to Medicare beneficiaries by hospitals, physicians, and other health care professionals. These data, which do not include any personally identifiable information, summarize the utilization and payments for procedures and services provided to Medicare fee-for service beneficiaries by providers. With this information, consumers have unprecedented access to information about how care is delivered in the Medicare program. In addition, CMS continues to make data available to consumers through the Compare tools. These tools allow consumers to compare nursing homes, hospitals or physicians throughout the country based on the quality measures reported to CMS. People can use this information to inform their selection of a provider and to discuss outcomes and performance levels with their primary care physician before receiving a referral.

Q-Corp is one of 13 QEs currently certified by CMS. We are looking forward to additional public reports from other QEs to help drive health care data transparency, improve quality, and reduce costs in the coming year.