In a move toward transparency and quality improvement, the Centers for Medicare & Medicaid Services (CMS) yesterday announced a final rule that will allow consumers, insurers, and employers to buy access to an extensive Medicare claims database, the Associated Press reports. The result will be data-rich performance report cards that evaluate providers on quality.
"This is a giant step forward in making our health care system more transparent and promoting increased competition, accountability, quality and lower costs," acting CMS Administrator Marilyn Tavenner said in a press release from the agency. "This provision of the health care law will ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar."
For years, consumer groups and quality advocates have complained that Medicare data has been piecemeal and limited, according to the press release. Performance data, thus far, comes from private insurance companies and focuses on primary care doctors. Critics of the insurer data argue they lack sufficient statistical power to rank specialists. But with the new access, Medicare's comprehensive claims data can offer a look into specialists' performance too, the AP notes.
Under the final rule, CMS opens up provider information--for a reduced price of $40,000 for the first year-- to qualified organizations that can extract Medicare claims data (Parts A, B, and D) to measure performance of providers, as well as suppliers. Qualified entities may receive data for one or more specific geographic areas and use it in combination with sources other than Medicare data when evaluating performance.
The new window into claims data isn't necessarily a welcomed one. Physician groups, including the American Medical Association, for years have fought to prevent the release of Medicare data for fear that patients--untrained in quality measurement--might take the information out of context.
Even more, providers also complained about the lack of opportunity to review the data before released. However, under the final rule, the entity must confidentially share the measures, methodology, and results with providers at least 60 days before making them public, allowing providers time to ask for corrections, if necessary.
The rule also includes privacy and security requirements, as well as penalties, to protect patients, providers, and suppliers against any misuse of Medicare data, according to the press release.
For more information:
- read the CMS press release
- here's the final rule (.pdf)
- read the AP article
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