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CMS pushes for quality-of-care reporting REGULATORY ISSUES

The Centers for Medicare & Medicaid Services (CMS)

proposed rules in June that will enable consumers and em- ployers to select hospitals and other healthcare providers in their area based on reports created using patient-protected Medicare data. Public reports on physicians, hospitals and other healthcare providers will combine private-sector claims data with Medicare claims data to identify which hospitals and doctors provide the highest-quality, most cost-effective care.

“Making more Medicare data available can make it easier for employers and consumers to make smart decisions about their healthcare,” says Donald M. Berwick, M.D., CMS administrator. “Making our healthcare system more trans- parent promotes competition and drives costs down.” How will the data be gathered and managed and the reporting compiled and released? According to CMS, the program would provide for the following activities: • CMS would provide standardized extracts of Medicare claims data from Parts A, B and D to qualifi ed entities. The data can only be used to evaluate provider and supplier performance and to generate public reports detailing the results.

• The data provided to the qualifi ed entity will cover one or more specifi ed geographic area(s). • The qualifi ed entity would pay a fee that covers CMS’ cost of making the data available. • To receive the Medicare claims data, qualifi ed enti- ties would need to have claims data from other sources. Combining claims data from multiple sources creates a more complete and accurate picture about provider and supplier performance.

• Publicly reporting the results calculated by the quali-

fi ed entity is important for transparency in healthcare and consumer empowerment. To prevent mistakes, qualifi ed entities must share the reports confi dentially with providers and suppliers prior to their public release. This gives provid- ers and suppliers an opportunity to review the reports and provide necessary corrections.

• Publicly released reports would contain aggregated information only, meaning that no individual patient/ben- efi ciary data would be shared or be available. • During the application process, qualifi ed entities would need to demonstrate their capabilities to govern the access, use and security of Medicare claims data. Qualifi ed entities would be subject to strict security and privacy processes. • CMS would continually monitor qualifi ed entities, and entities that do not follow these procedures risk sanctions, including termination from the program.

CMS says that comments are welcome on this set of proposed rules.

Symantec and Allscripts team up to provide security risk assessment


The Allscripts Privacy and Security Risk Assessment tool powered by Symantec

automates the paper-based process of assessing a medical practice’s privacy and security risks. It is designed to help physicians qualify for federal incentives for electronic health record (EHR) adoption under the American Re- covery and Reinvestment Act (ARRA). Physicians apply- ing for Medicare and Medicaid incentives under ARRA must demonstrate that their practices meet the security requirements under the Health Information Technol- ogy for Economic and Clinical Health Act (HITECH) meaningful-use Stage 1 criteria. They must also conduct a privacy and security risk analysis under Health Insurance Portability and Accountability Act (HIPAA) guidelines. The Allscripts solution is offered as a Web-based applica- tion, and no downloading or new hardware is required. The online tool also produces comprehensive reports immediately after the practice completes its assess- ment, including identifying potential gaps and providing recommendations for complying with HIPAA rules and HITECH. It is applicable for any EHR. Learn more about this solution at


“Over Our Heads: An Analogy on Healthcare, Good Intentions and Unforeseen Consequences” by Rulon F. Stacey, Ph.D., FACHE, (Fire Starter Publishing, 2011; $18.95), uses a neighborhood grocery store as a metaphor to trace the long and complicated history of healthcare policy in America and how it has caused the current healthcare crisis. “While the people who work in this industry are deeply caring and compassionate individuals, they are forced to work within a system that has become so convoluted and complex that it’s nearly impossible to comprehend the roots of the problem or to even keep up with current policy,” says Dr. Stacey, who was selected to be the 77th chairman of the board of governors of the American College of Healthcare Executives in 2011.


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