By John Reichard, CQ HealthBeat Editor
September 14, 2006 -- A bill introduced Thursday by Senate Budget Committee Chairman Judd Gregg, R-N.H., would allow employers and insurers access to Medicare claims data to study the cost and quality of health care services. "This bill will provide these groups with an enormous database to refine and improve their studies, and yield ways to improve the quality of the health care they offer at a lower price," according to a Gregg press release.
Dr. Arnold Milstein, a nationally recognized expert on efforts to measure the quality of care, said the bill is a "well-crafted and balanced legislative proposal" that would "bring enormous benefit to patients and their doctors."
Gregg said he is seeking enactment of the measure to improve the efficiency of U.S. health care. Gregg has spoken repeatedly about the need to rein in cost growth in health care spending and in Medicare spending in particular. "The United States spends more on health care as a percentage of the economy than any other industrialized country, and costs continue to rise," he said. "However, there is significant variation in the quality of health care consumers receive."
Backed by auto makers, business lobbies, insurers, and provider groups including the American Hospital Association and the American Nurses Association, the bill would limit the release of the data. Only groups designated as Medicare Quality Reporting Organizations (MQROs) would use the data to carry out studies. HHS would be required to conduct a review of the data to ensure patient privacy.
Employers, providers, consumer groups, labor unions, and others would be empowered to request reports from the MQROs, a bill summary said. The reports would have to be released publicly. The measure also would establish a Quality Advisory Board within HHS to develop quality standards for health care.
"The ability to analyze the full Medicare data set will enable the health care field to have a fuller picture of quality throughout an entire episode of care," said American Hospital Association Executive Vice President Rick Pollack. "It may enable us to identify opportunities to reduce readmissions and other complications of care."
In another measure to rein in health care spending, Rep. Michael C. Burgess, R-Texas, introduced legislation (HR 6053) on Wednesday under which state laws would require insurers to give patients an actual dollar estimate of what the patient must pay for health care items and services.
"Once we understand the actual cost, then we can begin to make effective changes leading to fair physician reimbursement, appropriate patient billing, and better medical services," Burgess said in a Sept. 13 letter urging House colleagues to support the bill.
The measure also calls for research on the types of information consumers find useful in making decisions regarding health care, and on how this information varies by the type of health insurance coverage an individual has. The research also would identify ways that pricing information could be distributed in a timely and simple manner.
The American Hospital Association issued a statement Wednesday supporting the Burgess bill. "With 32 states already requiring hospitals to report pricing information and six more voluntarily doing so, this legislation builds upon the good work the hospital field is already doing," said AHA's Pollack.