Case Study: Physician Feedback Reports Improve Quality, Efficiency, and Delivery of Care
By providing meaningful and actionable information to physicians so they can improve the care they deliver, CMS is moving toward physician reimbursement that rewards value rather than volume.
- Approximately 2.3 billion claims are processed each year at the beginning stage of the report generation cycle.
- Information is pulled from over 20 different and distinct data sources.
- The system contains more than 100,000 lines of code in approximately 25 distinct processing modules.
- Each report displays 36 exhibits and 6 graphs populated with information from over 3,200 data fields.
- These dynamic reports contain 24 paragraphs of customized explanatory text for each physician group based on group type, group size, and other factors.
- Extensive software modifications facilitate scale-up to the national level.
The United States spends a signficant amount on health care with relatively small returns on investment. To reduce spending and reorient toward value, CMS focused on physicians— the “front-line” of health care. CMS contracted with Mathematica and its partner to develop, produce, and disseminate comprehensive physician feedback reports to improve the quality, efficiency, and delivery of medical care.
Mathematica brought together a team well-versed in physician resource use and quality to manage, analyze, and interpret data and findings for CMS and paired them with highly skilled data scientists to manage report programming, analytics, and visualization. This project required billions of claims and data from third-party sources to be processed in an accurate, timely, and comprehensive manner. Mathematica combined its subject-matter expertise with its data management and analytics solutions to provide CMS with a unique, agile approach for generating rapid and comprehensive information to physicians and physician groups while maintaining data accuracy, security and quality.
Since 2008, Mathematica has provided fast, accurate and comprehensive reporting to physicians to improve the quality and value of care. Mathematica’s work has reached thousands of providers and will continue to impact the delivery and design of future reports at the national level. Key deliverables on this project include:
- Mathematica continues to advise and provide recommendations to CMS to refine approaches used to measure physician performance. This includes quick turnaround analyses that inform policy making through guidance on future enhancements to the approaches used to measure physician quality and efficiency.
- Supporting stakeholder materials for each QRUR year and level include a detailed methodology, FAQs, tips sheet to guide physicians and physician groups on how to utilize the reports, and reports summarizing the results shown in the QRURs.
- Mathematica will work with CMS and its partner to create reports that are accessible to stakeholders in the medical community, by continuing to refine and identify ways to provide detailed performance data to physicians that is useful and actionable to providers.
This case study is for informational purposes only. Mathematica Policy Research, a nonpartisan research firm, provides a full range of research and data collection services, including program evaluation and policy research, survey design and data collection, research assessment and interpretation, and program performance/data management, to improve public well-being. Its clients include federal and state governments, foundations, and private-sector and international organizations. The employee-owned company, with offices in Princeton, N.J.; Ann Arbor, Mich.; Cambridge, Mass.; Chicago, Ill.; Oakland, Calif.; and Washington, D.C., has conducted some of the most important studies of education, disability, health care, family support, employment, nutrition, and early childhood policies and programs.
As part of the 2010 Patient Protection and Affordable Care Act’s (ACA) goal of reversing trends in physician spending, Congress expanded the CMS mandate to apply value-based payment modifications to the physician fee schedule based on the quality of care that physicians and physician groups provided and the resources used to provide care.
CMS is changing the way it pays for care to better reward value and giving physicians information needed to become high value providers. By 2017, CMS will use value-based purchasing payments with all physicians and physician groups.
To drive improvement in value of care, CMS contracted with Mathematica to develop rigorous methodologies for evaluating physician performance and develop comprehensive reports with meaningful and actionable information for a variety of physicians and physician groups.
Mathematica is processing and analyzing Medicare claims data stored on the CMS Integrated Data Repository to produce Quality and Resource Use Reports for CMS to disseminate to physician and physician groups to encourage higher quality and more efficient care.
We assisted our partner in the creation of an interactive dashboard that delivers confidential feedback to providers; reports are updated in real time as new data are received.