This information is merged into the fee-for-service data sets to generate a comprehensive view of facts such as hospital discharges.
Part D of Medicare is administered by pharmacy benefit organizations that pay the claims rather than CMS’s doing so directly. Part D providers are required to submit detailed reports of the drugs prescribed as well as identifying the prescriber and the pharmacy where each prescription is filled.
Special supplemental information aimed at both monitoring quality and assigning patients to payment groups is collected on nursing home patients (the Minimum Data Set, or MDS), home health patients (the Outcome and Assessment Information Set, or OASIS), patients in rehabilitation facilities (Inpatient Rehabilitation Facility-Patient Assessment Instrument, or IRF-PAI), and those in psychiatric facilities (Inpatient Psychiatric Facility Prospective Payment System, or IPF PPS).
Quality information is collected from surveys done by the Joint Commission and state agencies and entered into the Online Survey Certification and Reporting (OSCAR) database. Since 2007, hospitals are required to report “never events,” adverse outcomes that ought not to have happened (such as wrong-site surgery), as defined by the National Quality Forum. Payment is withheld for the hospital stays during which such events occur. Additional quality reporting is also required. The amount of reporting is expected to increase as electronic medical records (EMRs) come into common use; ease of reporting should improve as well. Physicians are not required to submit quality information but have been encouraged to do so under a voluntary plan that can lead to incentive payments. Physicians’ quality reports are based on measures developed by the National Quality Forum. End-stage renal disease facilities report patient outcome measures into a system known as CROWNWeb, for Consolidated Renal Operations in a Web-enabled Network.
CMS also conducts a number of beneficiary surveys. The Medicare Current Beneficiary Survey (MCBS) is a rolling survey of beneficiaries that includes questions on out-of-pocket costs, services used, and the experience of care. The Health Outcomes Survey (HOS) measures outcomes for individuals enrolled in Medicare managed care. A survey specific to patients’ experience of hospital care—Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)—is also conducted.
Demographic information on beneficiaries, including race and ethnicity data, is provided to CMS by the Social Security Administration (SSA). According to recent reports, race and ethnicity information are now being collected using OMB standards when new Social Security and Supplemental Security Income claims are filed, and when applications are made