Hospital Quality Data: CMS Needs More Rigorous Methods to Ensure Reliability of Publicly Released Data

摘要

The Medicare Modernization Act of 2003 directed that hospitals lose 0.4 percent of their Medicare payment update if they do not submit clinical data for both Medicare and non-Medicare patients needed to calculate hospital performance on 10 quality measures. The Centers for Medicare & Medicaid Services (CMS) instituted the Annual Payment Update (APU) program to collect these data from hospitals and report their rates on the measures on its Hospital Compare Web site. For hospital quality data to be useful to patients and other users, they need to be reliable, that is, accurate and complete. GAO was asked to (1) describe the processes CMS uses to ensure the accuracy and completeness of data submitted for the APU program, (2) analyze the results of CMS's audit of the accuracy of data from the program's first two calendar quarters, and (3) describe processes used by seven other organizations that assess the accuracy and completeness of clinical performance data.