CMS proposes enhanced data, claim sharing

The Centers for Medicare & Medicaid Services today proposed rules to allow approved qualified entities to share or sell data and analysis of Medicare and private sector claims in hopes of supporting improved care in the healthcare sector.

The new rules are part of the Medicare Access and CHIP Reauthorization Act and will allow the organizations to share or sell the analysis of claims data to providers, employers and other groups, as well as directly providing or selling claims data to providers, the group said. The new rules also come with new annual reporting requirements and is part of a broader effort from the Obama administration to improve healthcare, CMS said.

“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,” CMS acting administrator Andy Slavitt said in prepared remarks.

The qualified entity program was part of the Affordable Care Act and allows qualifying organizations to access patient-protected Medicare data to produce public reports, though the reports must combine the Medicare data with other claims data to produce representative reports of how providers and suppliers perform across multiple payers, CMS said.

A total of 13 organizations have applied and received approval as qualified entities, and 2 of those 13 have completed public reporting. CMS said the rest of the organizations are preparing for public reporting.

Qualified entities, as listed by CMS, are: Oregon Health Care Quality Corporation, Health Improvement Collaborative of Greater Cincinnati, Maine Health Management Coalition Foundation, HealthInsight, California Healthcare Performance Information System, Pittsburgh Regional Health Initiative, Minnesota Community Measurement, Wisconsin Health Information Organization, Center for Improving Value in Health Care, Minnesota Department of Health, Division of Health Policy, Midwest Health Initiative, Health Care Cost Institute and Amino.

The CMS said it will be taking comments on the proposed rules up until March 29 this year.

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