CMS to Sell Medicare Data

Organizations that meet certain qualifications would have access to Medicare data to generate public reports on physicians, hospitals, and other health care professionals under the Availability of Medicare Data for Performance Measurement [PDF] rule the Centers for Medicare & Medicaid Services (CMS) proposed in early June. It is required by the 2010 health system reform bill.

CMS said in a news release it would sell standardized extracts of Medicare claims data from Parts A, B, and D to "qualified entities that have the capacity to process the data accurately and safely." The data could be used only to evaluate provider and supplier performance and generate public reports detailing those results. CMS has not yet specified what groups it is talking about, but officials said they would evaluate an organization's eligibility based on:

  • Organizational and governance capabilities;
  • Addition of claims data from other sources; and
  • Data privacy and security. 

Under the proposal, the organizations would share the reports confidentially with physicians before they are released in an attempt to prevent mistakes. Meanwhile, CMS says publicly released reports would include aggregated information only; individual patient and beneficiary information would not be available.

"We believe the sharing of Medicare data with qualified entities through this program and the resulting reports produced by qualified entities would be an important driver of improving quality and reducing costs in Medicare, as well as for the health care system in general," a CMS statement in the proposed rule said. "Additionally, we believe this program would increase the transparency of provider and supplier performance, while ensuring beneficiary privacy."

CMS will accept comments on the proposal until Aug. 8. Instructions for commenting are in the proposed rule.


Action, June 15, 2011


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