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APHA Scientific Session and Event Listing

Recorded presentation

Lisa Grabert, MPH, Program Integrity Group, Centers for Medicare and Medicaid Services, 7500 Security Blvd, Mailstop C3-02-16, Baltimore, MD 21244, 410-786-6827, lisa.grabert@cms.hhs.gov

In March 2005, the Medicare Payment Advisory Commission (MedPAC) released it's annual report to Congress recommending that the Secretary of the Department of Health and Human Services (DHHS) use Medicare claims data to measure fee-for-service resource utilization and educate physicians on their utilization of services compared to their peers. The Centers for Medicare and Medicare Services (CMS) developed tools called Resource Utilization Reports (RURs) using Medicare Part B claims with dates of service 1/1/2004 through 12/31/2004. Based on trends identified by MedPAC, CMS created RURs for the following services: Echocardiograms (ECHOs), Magnetic Resonance Imaging (MRIs), and Computed Tomography Scans (CTs). The RURs described to a physician his/her ordering patterns (e.g. where he/she ranks compared to peers). The CMS hypothesized that the RURs may encourage physicians to increase efficiency without sacrificing quality of patient care. To test this hypothesis, CMS held two physician focus groups consisting of cardiologists. In order to make the RURs meaningful and actionable, the physicians cited the need for: development of professional quality standards, risk adjusting for patient case mix on RURs, and examining the longevity of treatment by expanding the length of claims history. CMS will use the comments suggested by the cardiology focus groups to modify the MRI/CT RURs that will be used for future focus groups.

Learning Objectives: At the conclusion of this session, the participant will in this session will be able to

• Evaluate the effectiveness of Medicare claims date to educate physicians on their utilization of services.
• Recognize the need for specialty societies to develop standards of care.
• Recognize the wide variation in practicing patterns among different geographic locations.

Keywords: Quality, Performance Measurement

Related Web page: www.cms.gov

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation