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Baldwin, Thune Introduce Bipartisan Legislation to Reduce Costs and Increase Efficiency in Healthcare Delivery

Quality Data, Quality Healthcare Act Improves Transparency for Better Healthcare Decisions and Patient Outcomes

WASHINGTON, D.C. - U.S. Senators Tammy Baldwin (D-WI) and John Thune (R-SD) today introduced bipartisan legislation that increases the transparency of healthcare costs in Medicare—helping doctors, health systems, private insurers and research institutions provide more efficient, higher quality healthcare and better patient outcomes.

Medicare is the single largest payer of healthcare services in the country, spending over $600 billion each year. But we know very little about what we are paying for,” said Senator Baldwin. “The Quality Data, Quality Healthcare Act provides access to that data and puts it into the hands of those who can best use it, helping doctors make more informed decisions and improving how we deliver healthcare.”

“Almost every business relies on metrics to evaluate what it is doing well and what it needs to improve, CMS—America’s largest health care payer should be no different,” said Senator Thune. “Providing access to data that can be used to evaluate healthcare services is a critical component of increasing transparency and reducing healthcare costs. I hope our colleagues will join us in supporting this common-sense measure to improve the quality of healthcare while reducing costs.”

As the largest payer of healthcare in the United States, the Centers for Medicare and Medicaid Services (CMS) sits on a wealth of information that can help inform healthcare providers in making better decisions that will improve patient care and reduce costs. Economists have argued that expanding access to Medicare cost and utilization data will increase efficiency in healthcare delivery, reduce costs and improve the quality of care.

Recent efforts by the administration to increase access to Medicare data are promising, but they lack the necessary detail and context to be most useful.  The Qualified Entity (QE) program is a more promising effort created by Congress that allows organizations to access and analyze comprehensive Medicare data for select purposes. The QE program has the potential to empower our nation’s healthcare decision-makers to make better choices. However, current law is far too restrictive on which organizations can participate in the QE program, what QEs can do with the Medicare data once they have received it and the degree to which QEs can support their own data maintenance infrastructures.

The Quality Data, Quality Healthcare Act would provide for greater access to Medicare claims data by modernizing and reforming the QE program. The legislation would:

Allow organizations receiving Medicare data to analyze and redistribute it to authorized subscribers (insurers, health systems, and physicians) so that subscribers can make more informed decisions; and

Permit those entities to charge a fee to their subscribers so that the organizations can conduct robust analyses to improve healthcare quality and reduce costs. 

“The Wisconsin Medical Society applauds Senators Baldwin and Thune for the introduction of the Quality Data, Quality Healthcare Act.  We find ourselves in the midst of a time of great challenges and of great changes in healthcare delivery and payment.  As we proceed with the exciting transition from a payment system that is driven by volume, to a payment system that will be driven by value, reliable, accurate and comprehensive data will be the key to optimizing our success,” said Rick Abrams, Wisconsin Medical Society. “The Quality Data, Quality Healthcare Act will provide physicians and the organizations that represent them, easier access and use of Medicare data to improve healthcare quality and patient outcomes, to improve the health of the public and to reduce healthcare costs, thereby achieving a truly value-based healthcare delivery and payment system for our nation.”

We have been improving healthcare by reviewing health insurance claims data in Wisconsin since 2009. However, we have not been able to include Medicare claims data, one of the most important data sources for understanding healthcare utilization, quality and costs, in our process,” said Dr. John Toussaint, CEO, ThedaCare Center for Healthcare Value.The Quality Data, Quality Healthcare Act removes a huge barrier in our ability to improve care. I applaud Senator Baldwin and Senator Thune’s vision and leadership, and their commitment to improving the quality of healthcare for all Americans.”

The Wisconsin Health Information Organization (WHIO) commends Senator Tammy Baldwin and Senator John Thune for their work to expand access to Medicare data, and supports the introduction of the Quality Data, Quality Healthcare Act. WHIO uses health claims data to improve patient care in Wisconsin through increased transparency of healthcare quality and cost. Currently, WHIO only has access to private payer claims and Medicaid data,” said Josephine Musser, CEO, Wisconsin Health Information Organization. “With the Senators’ effort to make Medicare data more fully available, WHIO will have a more complete picture of quality and cost which it will use to better inform patients, employers, insurers and healthcare providers in Wisconsin. WHIO commends and thanks Senator Baldwin and Senator Thune for their efforts to improve quality and reduce costs in Wisconsin, South Dakota, and across the country.”

This bipartisan legislation, which Senators Baldwin and Thune first introduced last Congress, is supported by a broad coalition, including: AARP, American Academy of Family Physicians, ASC Association, Health Collaborative, National Coalition on Health Care, National Association of Manufacturers, National Consumers League, National Retail Federation, Network for Regional Healthcare Improvement, Pacific Business Group on Health, and Midwest Business Group on Health. In Wisconsin, the bill is supported by the ThedaCare Center for Healthcare Value, Wisconsin Collaborative for Healthcare Quality, Wisconsin Health Information Organization, Wisconsin Hospital Association, and the Wisconsin Medical Society

This approach was also included in the bipartisan, bicameral SGR Repeal and Medicare Provider Payment Modernization Act of 2014.

A summary of the Quality Data, Quality Healthcare Act can be found online here.