JAMA publishes Toussaint Berwick Commentary

Today, The Journal of the American Medical Association (JAMA) published an article by John Toussaint, M.D. and Donald Berwick, M.D. which describes several important changes that must happen legislatively and from a policy standpoint to lower cost and improve quality for Medicare beneficiaries.

The Affordable Care Act (ACA) allowed for fee-for-service Medicare data to be released to Qualified Entites (QEs). Unfortunately, fatal flaws in the wording of the statute 10332 do not allow physicians to have access to the entire data set. This means they can not drill down into the data to understand where performance issues may exist. This, in turn, means there is no chance for physicians to improve the cost and quality of medical care, the whole purpose for which the Medicare data release statute was written into the ACA in the first place.

At this point, legislative action will be required to fix this problem. At the Center, we have drafted such legislation and introduced it last December attaching it to the Sustainable Growth Rate "fix" legislation.  Unfortunately, Congress removed this from the final bill so the Medicare fee-for-service data remains inaccessible for improvement purposes by individual physicians.

In addition, we point out there are changes that could be made at The Center for Medicare and Medicaid Services that could have a positive impact on this issue.

1. Use HIPAA’s policymaking authority to permit providers to obtain and use data for specified purposes and to contract with QEs and others as business associates.

2. Allow data to be disclosed, for research purposes, to entities that want to create marketable products.

These changes allow for physicians to compare their performance to others to define best practice. The changes also support using the Medicare fee-for-service data for improvement.

Finally, we believe what we suggest is the ideal state for Medicare data transparency and will lead to tremendous improvements in the cost and quality of medical care. However, what we are suggesting is going to take congressional and presidential leadership. With hundreds of billions of dollars at stake and the solvency of Medicare in question we think it is time for our elected officials to act.

Click here to read the JAMA article.