CMS proposes release of claims data to help profile providers

The Centers for Medicare and Medicaid Services (CMS) has proposed releasing extracts of Medicare claims data that will be used to profile healthcare providers so that consumers and employers can make more informed choices. The healthcare reform law authorizes the release of this data.

CMS will make the Medicare data available only to "qualified organizations" that have demonstrated expertise in handling claims data and profiling providers. The proposal does not mention any organizations by name, but the Medstat subsidiary of Thomson Reuters and OptumInsight (formerly Ingenix)--a UnitedHealth Group company--both have such experience.

The profiling organizations will combine the Medicare data with the claims information of private insurers to provide a fuller picture of the quality performance of hospitals, physicians, and other providers.

The proposed rule includes requirements to safeguard the privacy and security of the claims data. The information would be aggregated to protect the identities of patients whose data was included in the extracts.

"Making more Medicare data available can make it easier for employers and consumers to make smart decisions about their healthcare," CMS Administrator Donald Berwick said of the proposed rule. "Performance reports that include Medicare data will result in higher quality and more cost-effective care."

There will be a 60-day comment period for the rules. 

To learn more:
- view the proposed rule in the Federal Register (.pdf)
- read this HealthLeaders Media article
- check out the Government Health IT piece 

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