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Medicare Will Release Data So Consumers Can Get More Accurate Rankings of Providers

By Rebecca Adams, CQ HealthBeat Associate Editor

Medicare officials released a proposed rule that would make claims data available that analysts can use to evaluate the performance of doctors, hospitals, and other providers.

For years, those who measure the quality of providers' care or rate their performance have been frustrated because they haven't been able to get Medicare data for their reports. In the past, they've relied on information from private health plans. Under the proposed rule, groups who prepare these analyses would be able to combine Medicare information with private insurance claims data and provide more complete public reports about which physicians and hospitals provide the best care.

Over the past decade, a wide range of groups have begun evaluating providers' performance in order to help consumers, employers and others choose the most cost-effective and highest-quality providers. Some groups that might be interested in using the Medicare data in their reports include the Pacific Business Group on Health, the Indiana Health Information Exchange, and the Robert Wood Johnson's Aligning Forces for Quality initiative.

"Performance reports that include Medicare data will result in higher quality and more cost effective care," said Donald M. Berwick, administrator of the Centers for Medicare and Medicaid. "And making our health care system more transparent promotes competition and drives costs down."

Niall Brennan, acting director in the Policy and Data Analysis Group in the CMS Center for Strategic Planning, said in an interview that the proposal fits in with the administration's overall aim of improving the quality of health care for seniors. Under Berwick, CMS officials have launched several initiatives in recent months that would encourage hospital officials or other providers to measure the quality of the care they are offering.

Brennan, who helped develop the rule, noted that the proposal would allow providers a chance to see the information before it is published and request corrections. CMS officials hope that the new policies and access to Medicare data will lead to more trustworthy information about providers that consumers and others can rely on.

"Making Medicare data available will make it easier to make smart decisions about health care," Brennan said.

The rule includes strict privacy and security requirements in order to reduce the risk that patients' personal health information could be exposed.

The Business Roundtable responded to the proposal with a statement calling the rule "a key step in addressing rising health care costs for all Americans and marks another positive milestone toward ensuring consumers have timely and accurate information on health care costs and quality."

"Business Roundtable CEOs have long called for the release of Medicare claims data so all consumers can know how much their health care costs and the quality of their providers," said the statement. "The actions by CMS today, along with congressional efforts and legal actions to obtain the data, are all critical. There is no reason why government data should not be available to ensure consumers have access to actionable and accurate information for their health care choices. In fact, it is long overdue."

The proposed regulation is expected to be published in the Federal Register on June 8 and will have a 60-day comment period.

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