CMS Rules Propose Sharing Claims Data With ‘Qualified Entities'
By Christine Kern, contributing writer
The rule would encourage analysis and sharing of the medical-claims data.
According to new proposed regulations issued by CMS, Medicare and private-sector medical-claims data and any analyses of that data could soon be shared by medical data miners. The CMS statement announced the proposal would give providers and employers access to information in order to drive quality and patient care improvements.
The statement reads, “The new rules, as required by the Medicare Access and CHIP Reauthorization Act (MACRA), will allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups who can use the data to support improved care. In addition, qualified entities will be allowed to provide or sell claims data to providers. The rule also includes strict privacy and security requirements for all entities receiving Medicare analyses or data, as well as new annual reporting requirements.”
The move is part of the broader initiative fostered by the Obama Administration to achieve the trifecta of healthcare: better care, more efficient spending, and healthier outcomes.
“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,” explained CMS Acting Administrator Andy Slavitt.
Qualified entities will be required to combine the Medicare data with other claims data in order to create analyses that look at performance across multiple payers, such as Medicare, Medicaid, or various commercial payers, CMS specifies.
To date, 13 organizations have applied and been approved to be qualified entities. One of those original qualified entities is the Wisconsin Health information Organization, an information exchange that is the all-payer claims database for the state.
Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value in Appleton, WI, told Modern Healthcare the MACRA provision would allow organizations like the Wisconsin Health Information Organization to accept Medicare data and then publicly report the performance of physicians both on cost and quality. “This is going to allow us to get down to the nitty gritty of best practices, who is doing what, and what works and doesn't work,” Toussaint said. “I think that's a pretty big change.”
The 86-page proposed rule can be viewed at the Office of the Federal Register, and comments are being accepted until March 29.