Will Using Medicare Data to Rate Doctors Benefit Patients?

Annals of Internal Medicine:  Rachel M. Werner, MD, PhD – February 13, 2012.

On 5 December 2011, the Centers for Medicare & Medicaid Services (CMS) announced that it will make its claims data available to rate health care providers on their quality of care (1). The goal of availing these data to the public is to enable consumers to make more informed choices about their health care providers. Many have hailed this as an important and necessary step to improve health care in the United States.

The final rule will give qualified organizations (such as consumer groups, employers, and insurers) access to all billing data from Medicare parts A, B, and D to create performance reports. To gain access to these data, organizations must to apply to Medicare to become a qualified entity, demonstrating that they have appropriate experience and expertise in using such data to rate performance. The qualified organization can then use these data to identify high-quality health care providers or create online tools to help consumers choose a provider. Each qualified organization will determine the specific uses and how and to whom the performance measures will be disseminated, but the expectation is to substantially increase the availability of performance ratings for consumers.

Performance ratings of health care providers have been made increasingly available to the public over recent decades, yet comprehensive ratings are available for only a few types of providers and are sometimes based on a limited portion of each provider’s patient pool. For example, the CMS has publicly rated hospitals, nursing homes, and home health agencies since the mid 2000s; however, comprehensive ratings of individual physicians’ care of common medical conditions are not available. Read More