Say Goodbye to Fee-For-Service Reimbursement?
On June 5, 2012, the Centers for Medicare & Medicaid Services (CMS) announced a new data and information initiative that CMS reports “will be a key tool in the agency’s evolution from a fee-for-service based payer to a value-based purchaser of care.” CMS reports that with timely, relevant data, CMS will be able to better define and reward high quality, low cost care. In other words, say goodbye to fee-for-service reimbursement.
The initiative includes the creation of a new CMS oversight group known as the Office of Information Products and Data Analytics (OIPDA). The goal of OIPDA is to make data management and information sharing a core function of CMS. OIPDA will assume responsibility for many current CMS data functions, including, but not limited to, the Chronic Condition Warehouse, the Medicare Current Beneficiary Survey, the Medicaid Analytic Extract, and the Research Data Assistance Center. The new data and information products being released pursuant to this new initiative are as follows:
- Medicare Geographic Variation Trend Data. A data set that leverages almost five billion Medicare claims into an easy-to-use data format that provides key metrics at the state and hospital referral region levels. The data set includes numerous variables such as demographics, spending, utilization, and quality of care, across several years (2007 – 2010). The data is on the Institute of Medicine website and will be available in the Health Indicators Warehouse by mid-summer 2012.
- Medicare Enrollment Dashboard. An online dashboard that provides a single location with comprehensive statistics on Medicare enrollment (Parts A, B, D, and Medicare Advantage), including detailed information on enrollment patterns on the national and state level for recent years, as well as historical trend data on overall Medicare enrollment beginning in 1966.
- Medicare and Medicare Research Review (MMRR). A peer-reviewed online journal on current and future directions of the Medicare, Medicaid, and Children’s Health Insurance programs was recently launched. MMRR will also publish CMS Data Briefs summarizing complex statistical topics in easier to understand language.
- CMS Data Navigator. A web-based search tool that connects researchers, policy makers, and the general public to CMS data resources. Search results will include publicly available data files, statistics, reports, fact sheets, and interactive tools. Navigator is scheduled to be in operation by mid-summer 2012 on the CMS website.
WHAT DOES THIS MEAN FOR PROVIDERS?
Healthcare providers will have to keep detailed and careful documentation in support of their clinical decisions and actions. OIPDA will be focused on the information providers create through their requests for payment. As a result of the Medicare Geographic Trend Data product, care trends and outcomes can be mapped and compared by diagnosis and service against claims made by providers. CMS wants not only to know what providers have done, but why it was done.