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

Modern Healthcare - - COMMENT - By Dr. John Tous­saint

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.

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