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Medicare Begins Making More Physician Data Available

More information on the quality and performance of physicians will be available from Medicare under a new rule adopted by the agency as part of the Affordable Care Act.

The rule allows "qualified entities" to apply for access to standardized extracts of Medicare claims data, said Niall Brennan, director of the policy and data analysis group at the Centers for Medicare and Medicaid Services.

Those groups will be allowed to combine the Medicare data with claims data from other sources to produce performance reports on health care providers.

The goal, Brennan said, is to "give consumers and employers the information they need to make the best choice of health care provider."

Marilyn Tavenner, acting CMS administrator, described the new rule as "a giant step forward in making our health care system more transparent and promoting increased competition, accountability, quality and lower costs."

"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," she said in a statement issued by the agency.

The new rule represents a break from the past. Typically, Medicare data has been closely guarded and shared only with academic researchers and Medicare contractors, Brennan said. Other groups received limited and piecemeal access to Medicare claims data.

"Traditionally, the Medicare program has been legally limited in how and for what it can disclose claims data to people," Brennan said.

Medicare began taking applications for access to the data this week.

For the first year of the program, the data will cost a qualified entity an average of $40,000, based on an assumption that there will be 25 such groups and that the average entity will request data for about 2.5 million beneficiaries, according to CMS.

Brennan said the claims data might prove most useful to Regional Health Improvement Collaboratives -- new nonprofit groups that are springing up under the Affordable Care Act to track medical performance and help bring better organization to a region's health care system. More than 40 of these groups now exist in the United States.

"Many of those organizations are already analyzing data from non-Medicare sources and are anxiously awaiting the opportunity to review Medicare claims data," Brennan said.

Access to the Medicare claims data will not be easy to obtain. Groups that want the data will have to sign agreements that make them subject to stiff penalties if they misuse the information. The groups also must prove that they:

  • Have access to other claims data resources that they will combine with the Medicare data to produce their performance reports.
  • Can protect patient privacy and maintain security of the data.
  • Will give physicians an opportunity to review and respond to their report before it is published.

Under the final rule, physicians will be able to access the same Medicare data used to produce a report so they can fact-check the document. The reports will be subject to a 60-day review period before publication.

As Brennan explained, "doctors will have an opportunity to confidentially review and, if necessary, appeal the reports produced by qualified entities."

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January 11, 2012
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