CMS Releases Medicare Data for Quality-Based Metrics
CMS has released new data on ethnic and racial backgrounds of Medicare Advantage beneficiaries, which will allow for analysis related to quality-based metrics within various populations.
By - The Centers for Medicare & Medicaid Services (CMS) is further attempting to innovate and improve medicine through quality-based metrics, as the CMS Office of Minority Health has released new data that provides more information on the quality of care patients who have Medicare Advantage based on ethnic and racial backgrounds.
The data that was collected is based on two different groups of information, according to a press release from CMS. First, the Healthcare Effectiveness Data and Information Set (HEDIS) was used to collect more medical records and administrative data. HEDIS is used to figure out whether Medicare beneficiaries receive quality care for a variety of different medical conditions such as chronic lung disease, diabetes, or heart disease.
“This is the first time that CMS has released Medicare Advantage data stratified by race and ethnicity. Increasing understanding and awareness of disparities and their causes is the first step of our path to equity,” Dr. Cara James, Director of the CMS Office of Minority Health, said in a public statement. “While these data do not tell us why differences exist, they show where we have problems and can help spur efforts to understand what can be done to reduce or eliminate these differences.”
The second area from which the Medicare Advantage data was gathered came from the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey, a consumer poll that CMS conducts yearly.
HEDIS and CAHPS scores from the database look at the individual ethnic and racial backgrounds of each group within Medicare contracts. This new database is meant to stimulate providers to improve the quality of care for Medicare Advantage beneficiaries and well as hold hospitals and physicians more accountable for ensuring patient health outcomes are stronger.
The star ratings program Medicare Advantage and Part D Star Ratings program is not used to analyze medical care by using the database provided by the CMS Office of Minority Health. It is also not used for reimbursement between providers and the federal agency, the CMS press release states.
A report outlining this data shows that Asians and Pacific Islanders receive similar or better medical care compared to Caucasian people. However, the report also discussed the discovery that African-American and Hispanic people received similar or worse medical care than their white counterparts.
“These data are a good first step in understanding disparities in Medicare Advantage,” said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. “We look forward to working with plans in closing the differences in the quality of care that people with Medicare Advantage receive.”
This type of information can help CMS and hospitals identify any gaps in care and racial disparities that occur throughout the medical field. Hopefully, by utilizing this data, medical facilities can close these gaps in care.
CMS has also revamped its Medicare Part B Drug Prescribing system in recent years. HealthPayerIntelligence.com spoke to Dr. Bill Bithoney and Dr. David Friend, Managing Directors of BDO’s Center for Healthcare Excellence & Innovation, about Medicare Part B and its transformations.
“People have been against Medicare negotiating prices in the past because they assumed that we do the exact same thing – let Medicare negotiate price based on the average wholesale cost and, therefore, it would work as badly as it does now,” Bithoney said.
“It’s not clear what would happen. If it’s done the old-fashioned way, that certainly won’t work. If it’s done in a different way, it could well work. What CMS is doing and is able to do theoretically is to reach a mutual agreement with drug companies as opposed to negotiate. I don’t know how subtle or fine that line is.”
“The proposal is that they can enter into consensual arrangements about how much Medicare will pay. Getting this on the radar of CMS is incredibly important and also looking at value-based pricing in using the model is vital.”
From value-based care reimbursement to new analytics systems and federal regulations, the current healthcare industry landscape has evolved dramatically from the prior fee-for-service payment models. As CMS and the healthcare industry continues to reform, new sources of data and innovative analytics solutions will bring support for providers and hospitals seeking to strengthen their patient health outcomes and quality care initiatives.
