Rule to Allow Access to Medicare Data on Providers

The following article comes from and covers a very controversial and important topic for providers. Certainly the intentions are good and there is plausible benefit from this move. However, there is ample room for misuse and improper interpretation of the data that could create significant problems for providers. We’re interested to get feedback from providers on this. How do you feel about it?

The CMS has proposed a new rule (PDF) that would allow organizations that meet certain qualifications access to patient-protected Medicare data to produce public reports on physicians, hospitals and other healthcare providers.

According to the agency, these reports would combine Medicare claims data with private-sector claims data to identify which physicians and hospitals provide the highest quality, most cost-effective care to patients. In this initiative, the CMS would provide standardized extracts of Medicare claims data from Parts A, B and D for a fee to qualified entities that have the capacity to process the data accurately and safely. The data could then be used only to evaluate provider and supplier performance and generate public reports detailing those results.

The rule also calls for these organizations to share their reports confidentially with providers and suppliers before they’re released in an effort to prevent mistakes. Meanwhile, publicly released reports would include only aggregated information only, which means individual patient and beneficiary information would not be shared.

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

The proposed rule will be published in the Federal Register on June 8, and the CMS will accept public comments for 60 days following that date.

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