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Provider Profiling & Medicare

Senator Gregg Introduces Bill to Improve Health Care Quality and Reduce Costs

Release of Medicare data will benefit patients while ensuring proper safeguards

WASHINGTON -- U.S. Senator Judd Gregg (R-NH) today introduced the Medicare Quality Enhancement Act, a measure designed to improve the quality of health care for patients while lowering costs.

The bill authorizes the release of Medicare data to qualified organizations, known as Medicare Quality Reporting Organizations (MQRO), so they can develop reports on the cost and quality of health care while including necessary safeguards to protect patient privacy. Any reports or results derived from this data must be released to the public within one year.

"The United States spends more on health care as a percentage of the economy than any other industrialized country, and costs continue to rise," said Senator Gregg, Chairman of the Senate Budget Committee and former Chairman and current member of the Senate Health, Education, Labor and Pensions Committee. "However, there is significant variation in the quality of health care consumers receive."

"Attempts are already being made by employers and insurance companies to measure the quality of health care they are receiving," said Chairman Gregg. "However, with limited amounts of privately held data, their analysis is not broad enough to provide the most accurate results. This bill will provide these groups with an enormous database to refine and improve their studies, and yield ways to improve the quality of the health care they offer at a lower price without compromising the safety of Medicare beneficiaries."

"This well-crafted and balanced legislative proposal would bring enormous benefit to patients and their doctors," said Dr. Arnold Milstein, MD, co-founder of the Leapfrog Group, a program aimed at mobilizing employer purchasing power for health care. "In today's ‘performance-blind' environment, both have struggled with only rare success to attain consistently excellent and affordable care. When enacted, it would enable both to understand their current starting point and accelerate their shared pursuit of breakthrough in clinical excellence and affordability."

Privacy of Medicare information is ensured by requiring that all Medicare Quality Reporting Organizations protect individual beneficiary privacy under the Health Insurance Portability and Accountability Act and the Privacy Act. The bill also requires a privacy review by the Department of Health and Human Services of any analytical report prepared by an MQRO prior to its release.

In recent years, consumer groups, employers, insurance companies, and others have repeatedly requested access to Medicare claims data in order to improve the quality and reduce the cost of the health care they provide.

The bill is endorsed by:

  • The American Nurses Association
  • The American Hospital Association
  • Consumers' Checkbook/Center for the Study of Services
  • Corporate Health Care Coalition
  • HR Policy Association
  • American Benefits Council
  • Business Roundtable
  • ERISA Industry Committee
  • National Retail Federation
  • Aetna
  • Verizon Communications
  • Motorola
  • Ford Motor Company
  • General Motors Corporation
  • Mercer Human Resource Consulting

Medicare Quality Enhancement Act

Summary

The United States spends more on health care as a percentage of the economy than any other industrialized country and costs continue to rise. However, there is significant variation in the quality of health care consumers receive. The Medicare Quality Enhancement Act seeks to improve U.S. health care by providing qualified private-sector organizations access to Medicare data for the development and release of reports on the quality, cost, efficiency, and effectiveness of our health care system.

Background:

Consumer groups, employers, insurance companies and others have repeatedly requested access to Medicare claims data to improve the quality of the health care provided to their members, employees and beneficiaries and to help control the ever-rising costs of health care. While there remains legal debate over whether this data can be released, the Medicare Quality Enhancement Act ensures that the data collected by Medicare and paid for by the taxpayer can be utilized by qualified organizations to measure quality and control costs while protecting beneficiary privacy.

How the Medicare Quality Enhancement Act Will Help

The Medicare Quality Enhancement Act:

  • Requires the Centers for Medicare and Medicaid Services to provide Medicare enrollment, claims, survey and assessment data to private sector Medicare Quality Reporting Organizations (MQROs) to develop reports to measure health care quality for the public;
  • Mandates the protection of beneficiary privacy;
  • Empowers consumer groups, providers, employers, insurance plans, labor unions and others to request reports from MQROs; and
  • Provides for the public release of all reports.

Attempts are already being made by employers and insurance companies to measure quality. However, with limited amounts of privately held data, their analysis is not broad enough to provide the most accurate results. However, MQROs will have access to Medicare data and be authorized to aggregate both private and public data, providing a significantly more robust assessment of both quality and efficiency while requiring the complete protection of beneficiary health information.

The bill also promotes existing efforts to develop model quality standards and methodologies for establishing and applying such standards. Through the formation of a Quality Advisory Board within the U.S. Department of Health and Human Services, the bill encourages the Administration to continue its extraordinary work with providers, consumers, insurers and others in the health care community toward sound quality measurement for all patients.

Why the Medicare Quality Enhancement Act is Necessary

In order for America's health care system to improve, we need to understand the quality of the care we are purchasing. The Medicare Quality Enhancement Act begins to provide health care consumers with the information they need to make educated decisions about health care; information they already have to make decisions on other products they purchase in the marketplace. The Medicare Quality Enhancement Act requires that information paid for by the taxpayer and held by Medicare is fully available to improve our health care system. The public will then finally have the tools necessary to make informed health care decisions for themselves and their families.