Practice Economics

CMS proposal would allow sharing, selling of claims data



Physicians may soon be able to purchase reports that combine their Medicare and private payer claims data, according to the details of a new government proposal.

The proposed rule, released on Jan. 29, would enable entities approved by the government to share or sell Medicare and private claims information to health providers, suppliers, hospital associations, and medical societies. The new rule, as required by the Medicare Access and CHIP Reauthorization Act (MACRA), seeks to increase transparency about provider performance and generate data uses that improve care delivery, according to a statement from the Centers for Medicare & Medicaid Services.

Andy Slavitt

Andy Slavitt

“Increasing access to analyses and data that include Medicare data will make it easier for stakeholders throughout the healthcare system to make smarter and more informed healthcare decisions,” CMS Acting Administrator Andy Slavitt said in a statement.

Under the rule, qualified entities may provide or sell data or analyses of the data to providers and suppliers. CMS encourages the sharing of data analytics that would assist in quality and patient care improvement activities, including the development of new models of care.

Disclosure or use of data for marketing purposes would be barred.

The rule includes strict privacy and security requirements for all entities receiving Medicare analyses or data.

If finalized, the rule could help practices in their efforts to provide value-based care and perform population management, said Dr. Yul D. Ejnes, chair-emeritus of the American College of Physicians Board of Regents and an internist in private practice in Cranston, R.I.

Dr. Yul D. Ejnes

Dr. Yul D. Ejnes

“A barrier, especially for small groups, is access to all-payer data, since what is available now is often partitioned by payer and not easy to compile into practice-wide data covering all patients,” he said in an interview. “Clearly, there is also a need for analysis of the data that is beyond the reach of most practices and is best done by third parties with the resources and expertise, so making the CMS data available facilitates that.”

However, Dr. Ejnes questioned how much these analyses will cost practices, especially smaller practices.

“Another related issue, beyond CMS’ purview, is how affordable this type of data analysis would be for the small practice that might benefit the most from it, since larger organizations have resources that may make much of this available to its physicians at little or no cost,” he said.

Entities supplying the information to providers must be accepted into the qualified entity program. The program, authorized under the Affordable Care Act, allows organizations that meet certain criteria to access patient-protected Medicare data to produce public reports. Qualified entities must combine the Medicare data with other claims data to produce reports that are “representative of how providers and suppliers are performing across multiple payers.”

Thus far, 13 organizations have been accepted into the program. Of these organizations, 2 have completed public reporting, while the other 11 are preparing for public reporting, according to CMS.

Comments on the new rule are due by March 29.

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