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Medicare Unveils Plan for Private Sales of Claims Data

By Kerry Young, CQ Roll Call

January 29, 2016 -- The Centers for Medicare and Medicaid Services (CMS) on Friday unveiled a plan for broadening access to its rich trove of health data, a move intended to eventually help doctors and purchasers of medical care make better decisions.

CMS posted a draft rule showing how it intends to carry out a mandate established as part of  last year's overhaul of Medicare's payments to physicians (PL 114-10). Lawmakers and CMS officials intend to build on efforts already underway to unlock valuable information long buried within the agency's records.

The 2010 health law established a process for the limited dissemination of Medicare claims data for the purpose of evaluating the performance of doctors and other health care providers. A provision in the 2015 physician overhaul will let so-called qualified organizations, which need to secure special CMS approval, conduct private analyses and sell them to authorized users for certain purposes. Steps will be added to the protocols already in place regarding oversight of the use of this data, CMS said.

So far, 13 organizations have made successful applications for access to data under the terms set by the 2010 health law. Two have completed some form of public reporting, while the other 11 are in various stages of preparing to do so, CMS said.

The changes made by Congress last year "will drive renewed interest in the qualified entity program, leading to more transparency regarding provider and supplier performance and innovative uses of data that will result in improvements to the healthcare delivery system while still ensuring appropriate privacy and security protections for beneficiary-identifiable data," CMS said.

Comments are due on the CMS draft rule by March 29.

Medicare claims data are considered a key resource for researchers seeking to understand what approaches and treatment to care work best. The program is the nation's largest single purchaser of health care, with average annual spending of about $600 billion. It also represents the populations typically most in need of health care, covering the elderly and disabled.

Kerry Young can be reached at [email protected].

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