Medicare claims data should be more easily accessible to help healthcare leaders improve care and reduce costs, according to a commentary in the Journal of the American Medical Association.
Currently, section 10332 of the Patient Protection and Affordable Care Act allows the release of Medicare claims data to "qualified entities" that meet certain criteria. QEs can combine the claims data with claims information from other payers to create a more complete, publicly available performance report. However, CMS has been slow to certify QEs, and regulations limit what QEs can do with the data, according to commentary authors John S. Toussaint, MD, CEO of the ThedaCare Center for Healthcare Value in Appleton, Wis., and Donald M. Berwick, MD, former administrator of CMS.
The authors propose two steps to enhance the usefulness of Medicare claims data released to QEs:
1. "Permit the QE to reuse and redisclose the data for other statutorily allowable purposes." For example, allowing QEs to share the data with physicians can help physicians identify cost and performance areas for improvement.
2. "Allow a QE to create or sustain revenue-generating business models consistent with the mission of the QE program." QEs should be allowed to ask willing providers to pay a subscription fee for analytics and other services related to the Medicare data, according to the commentary.
The authors also propose two changes to CMS policy to make Medicare claims data more widely accessible:
1. "Use the policy making authority of HIPAA to permit providers to obtain and use data for specified purposes and to contract with QEs and others as business associates."
2. "Allow data to be disclosed, for research purposes, to entities that want to create marketable products."
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