Medicare: Certain Physician Feedback Reporting Practices of Private Entities Could Improve CMS's Efforts Page: 2 of 51
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Highlights of GAO-14-279, a report to
Why GAO Did This Study
Health care payers-including
Medicare-are increasingly using VBP
to reward the quality and efficiency
instead of just the volume of care
delivered. Both traditional and newer
delivery models use this approach to
incentivize providers to improve their
performance. Feedback reports serve
to inform providers of their results on
various measures relative to
established targets. The American
Taxpayer Relief Act of 2012 mandated
that GAO compare private entity and
Medicare performance feedback
GAO examined (1) how and when
private entities report performance
data to physicians, and what
information they report; and (2) how
the timing and approach CMS uses to
report performance data compare to
that of private entities. GAO contacted
nine entities-health insurers and
for their performance reporting
programs. Focusing on physician
feedback, GAO obtained information
regarding report recipients, data
sources used, types of performance
measures and benchmarks, frequency
of reporting, and efforts to enhance the
utility of performance reports. GAO
obtained similar information from CMS
about its Medicare feedback efforts.
What GAO Recommends
The Administrator of CMS should
consider expanding performance
benchmarks to include state or
regional averages, and disseminating
feedback reports more frequently than
the current annual distribution.
View GAO-14-279. For more information,
contact James Cosgrove at (202) 512-7114 or
Certain Physician Feedback Reporting Practices of
Private Entities Could Improve CMS's Efforts
What GAO Found
Private entities GAO reviewed for this study selected a range of measures and
benchmarks to assess physician group performance, and provided feedback
reports to physicians more than once a year. Private entities almost exclusively
focused their feedback efforts on primary care physician groups participating in
medical homes and accountable care organizations, which hold physicians
responsible for the quality and cost of all services provided. They limited their
feedback reporting to those with a sufficient number of enrollees to ensure the
reliability of reported measures. The entities decided on the number and type of
measures for their reports, and compared each group's performance to multiple
benchmarks, including peer group averages or past performance. All the entities
used quality measures, and some also used utilization or cost measures.
Because of the variety of quality measures and benchmarks, feedback report
content differed across the entities. Some entities noted that in addition to
national benchmarks, they compared results to state or regional level rates to
reflect local patterns of care which may be more relevant to their physicians.
Most health insurers spent from 4 to 6 months to generate their performance
reports, a period that allowed them to amass claims data as well as to make
adjustments and perform checks on the measure calculations. Commonly,
private entities issued interim feedback reports, covering a 1-year measurement
period, on a rolling monthly, quarterly, or semiannual schedule. They told GAO
that physicians valued frequent feedback in order to make changes that could
result in better performance at the end of the measurement period.
Feedback from the Centers for Medicare & Medicaid Services (CMS) included
quality measures determined by each medical group, along with comparison to
only one benchmark, and CMS did not provide interim reports to physicians. The
agency has phased in performance feedback in order to meet its mandate to
apply value-based payment (VBP) to all physicians in Medicare by 2017, a
challenge not faced by private entities. In September 2013, CMS made feedback
reports available to 6,779 physician groups. While private entities in this study
chose the measures for their reports, CMS tied the selection of specific quality
measures to groups' chosen method of submitting performance data. Although
both CMS and private entities focused their feedback on preventive care and
management of specific diseases, CMS's reports contained more information on
costs and outcomes than some entities. While private entities employed multiple
benchmarks, the agency only compared each group's results to the national
average rates of all physician groups that submitted data on any given measure.
CMS's use of a single benchmark precludes physicians from viewing their
performance in fuller context, such as relative to their peers in the same
geographic areas. CMS's report generation process took 9 months to complete,
several months longer than health insurers in the study, although it included
more steps. In contrast to private entity reporting, CMS sent its feedback report
to physicians once a year, a frequency that may limit physicians' opportunity to
make improvements in advance of their annual payment adjustments.
The Department of Health and Human Services generally concurred with GAO's
recommendations and asked for additional information pertaining to the potential
value of using multiple benchmarks to assess Medicare physicians' performance.
United States Government Accountability Office
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United States. Government Accountability Office. Medicare: Certain Physician Feedback Reporting Practices of Private Entities Could Improve CMS's Efforts, report, March 26, 2014; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc300690/m1/2/: accessed September 20, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.