JAMA piece urges release of Medicare Advantage encounter data

Medicare written on paper with a stethoscope
If Medicare Advantage encounter data are good enough to be used for calculating payments to insurers, it should be good enough to provide to researchers, argues a new JAMA Viewpoint piece. (Getty/Design491)

Despite concerns about the quality of Medicare Advantage encounter data, it’s long past time to make that information available to researchers who want to study the ever-growing privatized Medicare program.

That’s the argument of a new Viewpoint piece published by the Journal of the American Medical Association, which is largely a reaction to the Centers for Medicare & Medicaid Services’ decision last June to cancel the release of data on MA enrollees’ diagnoses and the services they received.

CMS said at the time that it made that decision because of concerns about the data’s accuracy. Indeed, the health insurance industry has been vocal about its qualms with the system used to capture encounter data, though America’s Health Insurance Plans said in June that it didn’t ask CMS to halt the release of the data.

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A recent HHS Office of Inspector General report found that only 5% of the records it reviewed contained a potential error after CMS made corrections. However, the agency did say that more must be done to ensure the accuracy of the data so that they can be used to conduct better oversight over the MA program.  

The authors of the JAMA piece—ProPublica reporter Charles Ornstein, former CMS Chief Data Officer Niall Brennan and health economist Austin Frakt—acknowledged those concerns but pointed out that the same data are already being used to calculate risk adjustment payments to insurers. If that information is good enough to be used for calculating payments, they argue, it should be good enough to provide to researchers, who are well-equipped to deal with any data limitations and can also help identify which data elements are of the highest quality.

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Even more importantly, though, researchers could use the data to determine the Medicare Advantage program’s strengths and weaknesses, as well as whether private insurers are being good stewards of taxpayer money. For example, they could explore whether MA provides benefits more efficiently than traditional Medicare, whether physicians uses services similarly for patients in either version of Medicare, or whether certain populations are better served by either program.

“For the past few years, those not directly involved in running Medicare Advantage have been squinting through keyholes to make some sense of what it provides,” the JAMA article concluded, adding that now is the time to bring the program “into the full light of day.”

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