Background

The Centers for Medicare & Medicaid Services (CMS) is committed to providing information to beneficiaries to assist them in making health care decisions as well as to assist providers to improve quality and value in health care. In support of the four cornerstone goals articulated in Executive Order 13410, specifically the goal of "measuring and making available results on the quality of health care delivery," CMS has contracted with Masspro, the Quality Improvement Organization for Massachusetts, to generate medical group practice performance measurement results based on Medicare administrative data.

The results calculated by Masspro based on Medicare Part B claims for the "Generating Medicare Physician Quality Performance Measurement Results" (GEM) project provide medical group practice performance on a set of quality measures representing a limited subset of the practice's patients. It is intended that these data be combined with commercial payer data to develop a more comprehensive picture of medical group practice performance that can then be shared with consumers.

The measurement information is being shared with local communities known as Chartered Value Exchanges (CVEs). CVEs are regional collaboratives recognized by the Department of Health and Human Services (DHHS) as exhibiting a strong commitment to improving quality and value in health care. CVEs are partnerships of providers, insurers and consumers that have been established to support DHHS' goal of a value-driven health care system.

For more information about Value-driven Health Care, click the Value-driven Health Care Initiative link in the Related Links Outside CMS section below.

For more information about Chartered Value Exchanges, click the CVE link in the Related Links Outside CMS section below.

For a list of Chartered Value Exchanges, click the link in the Related Links Outside CMS section below.

Data

CMS is providing Medicare Fee-for-Service (FFS) population and medical group practice level performance measurement results for CVEs in a phased approach. The results are calculated using Medicare FFS administrative data from 2006 and are available as downloadable files in the Downloads section below. This project uses methodologies that allow for performance results to be aggregated with similar projects in the commercial market. Note: Results for measures 1 - 5 were updated and reposted on September 5, 2008.  These updated measure rates reflect a correction in the number of claims used to calculate the measures.

The measures include the following:

1. Breast Cancer Screening
2. LDL Testing for Diabetics
3. Retinal Eye Exam for Diabetics
4. HbA1c Testing for Diabetics
5. Cardiovascular LDL Testing
6. Colorectal Cancer Screening
7. Nephropathy Testing for Diabetics
8. Persistence of Beta Blocker Therapy - Post MI
9. Annual Monitoring for Patients on Persistent Medications
10. Anti-Depressant Medication Management - Acute Phase
11. Beta Blocker Treatment After Heart Attack
12. Disease-Modifying Anti-Rheumatic Drug Therapy

Timeline for Release of Quality Measures

Results for measures 1 through 12 for all 50 states will be posted in September 2008.

For Technical Information Regarding the Measures Calculations

For additional information about how medical group practices were identified, how Medicare beneficiaries were attributed to medical group practices, limitations of the Medicare FFS administrative data and a detailed explanation of the measures, click the Technical Documents link at left. Note: Before reviewing or using the measurement data files it is important to read all of the information contained in the Technical Documents link at left.

Information about the Downloadable Files

The data results are provided in downloadable files below (Excel and comma-separated-value or csv files) and contain the measure rates for the medical group practices by state for a limited subset of the practices' patients. Also included are population results at the national level, the state level and the zip code level for each state. The data results are grouped by CMS-defined regions. Only regions with CVEs are displayed. Each region's zipped file includes data results for each state within the CMS region that corresponds to a CVE. The files do not contain individual patient or physician identifiable information. The files contain measures results, including numerators and denominators, at the individual medical group practice level, as identified by a practice Tax Identification Number (TIN).

Each region's file includes:

1. Zip code files for the state in csv and Excel format that include:

• National population results: denominator, numerator and rate (included as the first line in each state's zip code file)
• State population results: denominator, numerator and rate (included as the second line in each state's zip code file)
• Zip code level population results: denominator, numerator and rate.

2. Medical group practice files for each state in csv and Excel format that include:

• Medical Group Practice level results: denominator, numerator and rate

Downloads
Region 1 - Boston Region (MA, ME) [ZIP 279 KB] Region 2 -  New York Region (NY) [ZIP 558 KB] Region 3 - Philadelphia Region (PA) [ZIP 456 KB] Region 4 - Atlanta Region (TN) [ZIP 210 KB] Region 5 - Chicago Region (MI, MN, WI) [ZIP 651 KB] Region 6 - Dallas Region (LA) [ZIP 158 KB] Region 8 - Denver Region (UT) [ZIP 62 KB] Region 10 - Seattle Region (OR, WA) [ZIP 266 KB]
Related Links Inside CMS
There are no Related Links Inside CMS.
Related Links Outside CMS
For more information about Chartered Value Exchanges For more information on DHHS's Value-Driven Health Care For a list of Chartered Value Exchanges

Page Last Modified: 09/09/2008 7:42:55 AM
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