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Completing the Quality Puzzle: The Impact of Medicare FFS Data on Provider Performance Results in Oregon and Central New Mexico

Tuesday, November 3, 2015

Justine Wagner, Health Division, IMPAQ International, LLC, Columbia, MD
Melinda Warth, MA, Health Division, IMPAQ International, LLC, Columbia, MD
Research suggests that Medicare fee-for-service (FFS) beneficiaries are in poorer general health and have more chronic conditions than Medicare Advantage enrollees (Mirel et al., 2012). More broadly, the quality of care provided to patients has been shown to vary based on insurance type (Spencer et al., 2013). These discrepancies reflect a need to assess provider performance across all insurance types to ensure vulnerable populations are not receiving a substandard level of care. Under the ACA-mandated CMS Qualified Entity (QE) Medicare Data Sharing Program, organizations are able to incorporate Medicare FFS data into their existing public provider performance reporting initiatives for the first time.

The goal of this research is to analyze the effect of Medicare FFS data on provider performance in Oregon and central New Mexico, the first two regions included in public reports released by QEs under the QE program. For the Oregon QE, after incorporating Medicare FFS data, 5 out of 6 quality measures dropped below previous national benchmark levels. Specifically, two measures (kidney disease monitoring and cholesterol testing) dropped to below the national mean, two measures (blood sugar screening and breast cancer screening) dropped to the national mean, and one measure (eye exams for diabetics) dropped to below the national 90th percentile. For the New Mexico QE, inclusion of Medicare FFS data led to a decrease in both quality measures (breast cancer screening and blood sugar screening).

Our results suggest that there is a continued need for Medicare FFS-focused quality improvement aimed at closing the quality of care gap based on insurance type. While it is still too early to determine whether the inclusion of Medicare FFS data in public reports will improve quality for the FFS population, the QE program’s transparency affords a new measurement baseline from which consumers, policymakers, and health care providers can collaborate.

Learning Areas:

Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Analyze the performance of providers in Oregon and central New Mexico before and after the inclusion of Medicare FFS data. Describe the ACA-mandated Qualified Entity (QE) program that authorizes certified "Qualified Entities" to use Medicare FFS data to publicly report on the performance of providers.

Keyword(s): Medicare, Performance Measurement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have spent several years working closely with organizations whose mission is to produce fair and reliable provider performance measures to enhance the quality of care provided to health care consumers. More specifically, for the past two years, in my role as Research Analyst at IMPAQ International, I provide technical assistance to organizations who are, for the first time, obtaining Medicare FFS data to include in their public provider performance reports.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.