Availability of Medicare Data for Performance Measurement

Final Rule Released on Medicare Data Claims

Last week CMS published the final rule on how Medicare claims data can be released and used. Part of the Affordable Care Act, the final rule outlines the release and use of standardized extracts of Medicare claims data for qualified entities to measure the performance of providers of services and suppliers. It also explains how entities can qualify to receive the data. Data will be standardized extracts of claims from Medicare Parts A, B, and D. The data will be used for the purpose of evaluation of the performance of providers and suppliers. The rule also details how entities must protect the privacy of Medicare beneficiaries.

The database has been basically confidential since 1979 when the AMA was able to get an injunction in response to a physician privacy lawsuit. The database has information on bills paid for 48 million people with yearly totals of $524 billion. It is said to be the “single best source of information about American health care.”

The data will be used by employers, insurance companies, and consumer groups to rate doctors and analyze how they have performed specific procedures. While the doctor’s individual information will be identifiable the patients personal data is de-identified and confidential.

Marilyn Tavenner, Acting CMS Administrator weighed in on the rule, “This is a giant step forward in making our health care system more transparent and promoting increased competition, accountability, quality and lower costs. This provision of the health care law will ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar.”

Read the CMS press release.