Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

CMS Shares New Qualified Entity Program Growth Developments

CMS announces new growth initiatives in the Qualified Entity program with approval of a second nationwide program to advance provider transparency efforts.

By Jacqueline DiChiara

- It is an exciting time for healthcare, says the Centers for Medicare & Medicaid Services (CMS).

Medicare Access and CHIP Reauthorization Act of 2015 QE program

Notable transparency developments are underway, wrote Niall Brennan, CMS Chief Data Officer and the Director of the Office of Enterprise Data and Analytics (OEDA), on CMS’s official blog yesterday.

According to Brennan, CMS has been a government leader in the advancement of data transparency; CMS released data on geographic variation in Medicare utilization and quality and data on provider level utilization.

“A commitment to making such resources available puts engaged and empowered individuals at the center of their care, which is essential to transforming our system to one that delivers better care, smarter spending, and healthier people,” Brennen asserted.

CMS confirms a second nationwide QE program

Brennen shared a series of “exciting developments” regarding the Qualified Entity (QE) program, which was established under the Affordable Care Act. QEs have begun releasing public performance reports, Brennen stated.

The QE program helps create publicly available performance reports and data.

This information is used to improve provider quality, bolster transparency efforts, and help employers, consumer groups, patients, and caregivers make more intelligent healthcare decisions.

There are currently 12 certified QEs. Eleven of these will report on a regional scale. One QE will report nationwide.

Now a second nationwide QE, Amino, has been given the green light.

“Today, I’m excited to announce further growth in the QE program with the approval of a second nationwide QE, Amino. With the addition of Medicare data, Amino will enhance its free service to help Americans make care decisions, including, for example, determining the providers from whom they choose to receive services,” Brennen wrote.

“Prior to the Affordable Care Act, provider reporting was fragmented, making it difficult for providers and consumers to access a comprehensive picture of provider performance on quality and cost. The QE program enables qualified entities to create a more complete picture of provider quality and cost of care by combing Medicare data with data from multiple health plans.”

“As we continue our effort to make actionable information available to consumers and providers alike, we are looking forward to the future release of a Notice of Proposed Rulemaking (NPRM) that will implement changes to the QE program enacted by Congress under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).”

“This legislation expands permissible uses and disclosures under the QE program. We look forward to receiving comments from interested stakeholders when the NPRM is released.”

A brief look back on QE’s beginnings

The very first QE program was The Health Care Cost Institute (HCCI).  HCCI confirmed one of the primary benefits of the QE program is the simple art of credibility.

“Public reporting, as permitted with these data, when combined with cost and quality data from commercial health plans and state Medicaid data will represent the most credible information source for consumers, regulators and employers on health care cost and quality variation,” said David Newman, HCCI’s Executive Director.


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