CMS Advised to Follow Private Sector Practices to Improve Physician Feedback Reports

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On March 26, 2014, the Government Accountability Office (GAO) released its report regarding the private sector’s physician feedback reporting practices and how implementation of such practices could improve CMS’s own reports to Medicare providers.  The GAO surveyed the provider reporting practices of nine private entities, including health insurers and statewide collaboratives consisting of providers, payers, and employers.  In reviewing these reporting practices, the GAO examined how and when the entities reported performance feedback to physicians, as well as the type of information they reported. 

The GAO concluded that the private entities reported performance feedback to physicians more frequently than CMS, and that the private entities’ performance feedback reports include a wider variety of quality benchmarks than CMS’s reports.  Currently, CMS issues its performance feedback reports annually, and includes only national benchmarks in those reports.  The GAO recommended that CMS issue performance feedback reports more than once per year and include state or regional benchmarks.  According to the GAO, including local benchmarks was an important feature of the private entities’ reports, as a physician could be performing above the national average but below that of his or her local peers. 

While CMS agreed with the GAO’s recommendations, the agency noted that it faced unique challenges in reporting to multiple provider types and specialty groups.  CMS also underscored its view that Medicare is a national program affecting all providers receiving fee-for-service payment, and all providers should be subject to the same benchmarks.  CMS is working to incorporate performance feedback reports in connection with the Affordable Care Act’s mandate to apply a value-based payment to all Medicare physicians by 2017.  The GAO’s report is available here.

Reporter, Paige Fillingame, Houston, +1 713 615 7632, pfillingame@kslaw.com.

Topics:  CMS, GAO, Healthcare, Medicare, Physicians

Published In: Health Updates

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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