transparent and made public in ways that are both meaningful and understandable to consumers.

The committee proposes that public reporting requirements precede changes in payment strategies to allow time for providers to give feedback on performance results and comparisons. To advance the pace of adoption, incentives should be offered for the submission of performance measurement data that contributes to public reports. Public reports can inform consumer choices only if they are presented in a manner that is meaningful and easily understandable. Over time, payment incentives for the submission of routine data should be phased out so that this pool of funds can be redirected to the development of measures for areas that are more difficult to assess.

Ways of Overcoming Barriers to Participation

In its deliberations, the committee recognized the importance of establishing the expectation that all Medicare providers would participate in public reporting and pay for performance. However, it also recognized that the pace of implementation, the breadth of measure sets applicable to specific types of providers, and the size and distribution of reward pools would need to vary depending on the availability of measures and the organizational and technological challenges faced by different providers in carrying out performance measurement and reporting.

Many types of Medicare providers, including hospitals, home health agencies, and Medicare Advantage plans, are already submitting performance data for public reporting. For these providers, CMS should begin pay-for-performance programs on existing measures immediately, and move toward comprehensive performance assessment systems and sizable reward pools during the next 3 years.

Although skilled nursing facilities are already publicly reporting data to CMS, the performance measures reflecting their treatment of Medicare beneficiaries are not yet adequate to support pay for performance. There are also currently few, if any, performance measures for other providers, such as clinical laboratories and ambulatory surgical centers. Efforts should begin immediately to develop and test performance measure sets so that these providers can begin to participate in public reporting and pay for performance as soon as possible.

CMS has already begun a voluntary reporting program for physicians on selected measures. CMS should immediately develop and implement a strategy for ensuring that virtually all physicians participate—on at least some measures—as soon as possible. This strategy will need to be sensitive to differences across specialties in the availability of performance measures



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