Data-sharing provisions of the SGR fix will open new opportunities for quality improvement
With President Barack Obama’s recent signing of legislation repealing the sustainable growth-rate formula for physician compensation and revising the Medicare qualified entity program, doctors will be paying more attention than ever to value. The impact w
A five-year journey: In 2010, physicians told us the state’s all-payer claims database—the Wisconsin Health Information Organization— did not have all the data necessary to accurately represent their practices’ performance. The key reason: Medicare data were not integrated with the commercial and Medicaid data sets.
Fast forward to 2013, when I coauthored a JAMA editorial with Dr. Don Berwick detailing the impact the lack of Medicare data had on individual physician performance on the congestive heart failure episode treatment group. Without Medicare data, the cardiologist we studied had only 17 episodes of CHF attributed to his practice. With the data, that number jumped to more than 30.
These examples and others launched our focused effort to include language in the SGR repeal and replacement bill that would allow Medicare data to be released to qualified entities.
One of the reasons we so aggressively pursued this was to enable more clinical quality improvement. The existing language in the Affordable Care Act clearly stated that Medicare data could not be used for improvement purposes, yet every legislator we talked with agreed this was not the intent of the healthcare reform law.
Our subsequent quest in pursuit of the necessary revisions included multiple visits to Washington, recommendations from national organizations, meetings with lawmakers and remarkable bipartisan support from the Wisconsin congressional delegation.
Impact of the new law: Healthcare information technology provisions under the SGR repeal law give purchasers and consumers more of the information they need to understand where value lies so they can reward better performers. In addition to easing restrictions on the use of Medicare data for qualified entities, it transforms the way physicians are paid for treating Medicare patients and ties payment to value. They will now receive bonuses and bigger yearly pay increases for the delivery of higherquality, lower-cost healthcare.
Up to this point, physicians have had little real incentive to abandon the fee-for-service model and work with health systems and payers to create models that reward population health improvement. Now they do.
Although the legislation is a monumental step forward, the final language left one key stakeholder without full access to the Medicare data: commercial insurers. These companies can request reports from qualified entities, but they will not be allowed to receive the raw data. In Wisconsin, we have created a robust public reporting mechanism because of the multistakeholder collaboration among insurers, providers, state government and employer groups. To leave one of those stakeholders out is problematic. We hope this shortcoming will be rectified in future congressional action.
Embracing change: I remember years ago when I received a report providing comparative data on my care of pneumonia patients relative to the performance of my colleagues. It showed the cost and length of stay of my care versus other internists. My initial inclination was that the data must be wrong. Once verified though, my next step was to figure out who was the highest performer and try to do the same.
This has been our overall experience in Wisconsin. When physician performance is accurately and publicly reported, quality improves. The new SGR replacement law and the qualified-entity provisions give providers access to a much larger universe of performance data that allows them to identify their own strengths and weaknesses and compare themselves to peers in any state and market.
Armed with this information, physicians will have a new platform for improvement and the ability to learn from others. It’s a game-changer like none we have witnessed in reform legislation to date, and that’s good news for our patients and our nation.
Dr. John Toussaint is CEO of the ThedaCare Center for Healthcare Value, based in Appleton, Wis.