Featured in the May/June 2013 Colorado Medicine.
Chet Seward, Senior Director, Health Care Policy
The drive to enhance the transparency and meaningfulness of health care cost and quality data in Colorado is advancing, and physicians from around the state are working to ensure that it’s done right.
Colorado Medical Society (CMS) is collaborating with the Center for Improving Value in Health Care (CIVHC) to help develop the processes, methodologies and specifics of physician performance public reporting by the all-payer claims database (APCD). As administrator of the APCD, CIVHC has committed to report comparative cost and utilization data publicly on a named payer, facility and provider group basis by the end of this year. The APCD has appealed for help from CMS in identifying quality and cost-effectiveness measures for certain chronic and preventive diseases and common medical procedures to support consumer-focused reporting.
The prospect of practice specific cost and quality reports available on the web for all to see elicits mixed responses from physicians ranging from gritted teeth to rolled eyes. Perhaps part of this perceived or real lack of value stems from prior experience with individual commercial health plan physician designation programs. Physicians are understandably wary about these programs given their opaque, complex and frequently flawed nature that has served to only heighten physician skepticism about the usefulness of these data. Colorado physicians have long struggled with these programs, even after CMS championed the passage of the first in the nation law in 2008 to mandate that these programs use both cost and quality measures and that they ensure appropriate appeals mechanisms.
That’s why the APCD work is important because it captures data from multiple payers and enables more comprehensive reporting. In effect, the APCD provides an opportunity to utilize a big picture view to create more meaningful and actionable data reports. Importantly, the looming, detailed APCD reports are a response to strident demands from consumers, employers and policymakers for better information about the cost and quality of Colorado health care.
Start with the end in mind
The CMS Committee on Physician Practice Evolution has been meeting about this project with CIVHC leaders since January. The ultimate goal of this initiative is to use and share data to improve care delivery and demonstrate physicians’ ability to provide high-quality, cost-effective care. To date much work has been accomplished and more remains before these reports go live at the end of this year. The group has used the following criteria to begin the process of selecting a small, meaningful and manageable set of physician performance measures for public reporting. Physician performance measures should be:
- Based on solid clinical evidence that is not controversial – wherever possible they should be based on nationally recognized standards;
- Reasonably easy and accurately collected from claims data;
- Meaningful and actionable by patients and physicians and able to guide quality movement;
- Transparent; and
- Standardized between the groups/payers who are measuring physicians.
A handful of chronic and preventive measures have been identified as a draft starter set for consideration, and work to identify simple and strong measures for common procedures is also progressing. Measures and conditions under consideration include hemoglobin A1C testing for diabetes, mammography screening, osteoporosis management, total knee and hip replacements, cardiac catheterization and coronary artery bypass grafts.
Future work will focus on vetting potential measures with physicians across the state, and then understanding and gaining consensus on attribution and risk adjustment methodologies that will be used in APCD reporting.
The committee recognizes that this type of public reporting will happen with or without CMS collaboration and being involved provides more opportunities to shape the process. While members are quick to note the flawed nature of claims data, they also emphasize that this is a start and a piece of a larger strategy by CMS to help physician members to develop and use data to improve the value of care.
Physician feedback critical
The roll out of more detailed physician performance reports by the all-payer claims database holds both promise and peril. If done correctly it can shed light on what is and isn’t working well in Colorado health care. And if done incorrectly it can further muddy an already cloudy atmosphere surrounding cost and quality transparency programs or even worse imperil physician reputations and practices.
CMS is committed to seeking physician feedback on this initiative. Outreach has begun with component and specialty societies and other physician driven organizations around the state. CMS believes that raising awareness and educating physicians around the state about the initiative will be as important as determining what will ultimately be measured and reported. Contact Chet Seward in the CMS offices (firstname.lastname@example.org) if you’d like to schedule a meeting with your local colleagues to discuss the APCD initiative and in turn prepare for future, larger transparency and quality improvement programs.