CMS Should Expand Medicare Physician Performance Benchmarks, Says GAO

The Centers for Medicare and Medicaid Services could learn a lot from private entities who are using multiple benchmarks to assess the performance of Medicare physicians, according to the Government Accountability Office. In a new report, GAO recommended that CMS consider expanding performance benchmarks to include state or regional averages, and disseminating feedback reports more frequently than the current annual distribution.

"While private entities employed multiple benchmarks, the agency only compared each group's results to the national average rates of all physician groups that submitted data on any given measure," the report states. "CMS's use of a single benchmark precludes physicians from viewing their performance in fuller context, such as relative to their peers in the same geographic areas."

GAO also noted that CMS's report generation process took 9 months to complete, several months longer than health insurers in the study. "In contrast to private entity reporting, CMS sent its feedback report to physicians once a year, a frequency that may limit physicians' opportunity to make improvements in advance of their annual payment adjustments," said government auditors. 

For its report, GAO chose six health insurers and three statewide healthcare collaboratives and interviewed them about: feedback report recipients, data sources used, types of performance measures and benchmarks, frequency of reporting, and efforts to enhance the utility of their performance reports. The nine private entities were selected by GAO because they either had experience with value-based payment (VBP) programs, which link a portion of physician compensation to achieving specified levels of performance, or they had innovative features in their performance feedback programs.

"Private entities GAO reviewed for this study selected a range of measures and benchmarks to assess physician group performance, and provided feedback reports to physicians more than once a year," states the report. "Private entities almost exclusively focused their feedback efforts on primary care physician groups participating in medical homes and accountable care organizations, which hold physicians responsible for the quality and cost of all services provided."

According to GAO, most health insurers spent from 4 to 6 months to generate their performance reports, a period that allowed them to amass claims data as well as to make adjustments and perform checks on the measure calculations. In addition, government auditors discovered that private entities issued interim feedback reports, covering a 1-year measurement period, on a rolling monthly, quarterly, or semiannual schedule. 

GAO did note, however, that CMS "has phased in performance feedback in order to meet its mandate to apply value-based payment to all physicians in Medicare by 2017, a challenge not faced by private entities," adding that VBP "can be used as a means to improving quality and efficiency in the traditional healthcare delivery environment by encouraging providers to address gaps in patient care and consider the likely costs and benefits of care."