Proposed Rules Could Hamper Patient Protection

Posted on Sep 18, 2011

Flickr / US Mission Geneva

Health and Human Services Secretary Kathleen Sebelius at a U.N. news conference.

Last year’s health care reform law promised to address the problem of the hundreds of thousands of patients killed each year by professional error. Outside groups were to be allowed to analyze hospital conditions and publicly report on the quality of care. But new rules proposed by the Centers for Medicare & Medicaid Services would severely limit the release of Medicare billing records that would be used in the analysis.

Consumer groups have criticized the proposed rules. Bruce Boissonnault, president and CEO of the Niagara Health Quality Coalition, a nonprofit that has independently measured the quality of health care since the mid-1990s, said the rules are overly complicated and intended to limit access to information mostly to industry insiders. “We will only see the scraps of information that the industry wants us to discuss,” he said. “It’s advertising wrapped in a lab coat.”

Health care providers counter that billing data alone cannot be relied upon to indicate quality of care. It is unclear to this blogger exactly what Medicare’s billing data consists of and whether it would be sufficient to make judgments about quality. Still, it appears that someone wants to make it difficult for outside groups to access records. See the criteria for qualification below. —ARK

ProPublica:

To qualify, a group would have to:

• Pay up to $200,000 for the data.
• Have its methods pre-approved before obtaining the data.
• Already possess billing information from other sources to combine with the Medicare data — an advantage to insurance companies.
• Limit public reporting to quality measures approved by the health-care industry.
• Present its reports and findings to every doctor and facility being measured before they are released to the public — a requirement that would make large-scale reports difficult.

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