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Medicare Is Simple
Friday, July 1, 2016
CMS Finalizes Rule Giving Providers and Employers Improved Access to Information for Better Patient Care
CMS Finalizes Rule Giving Providers and
Employers Improved Access to Information for Better Patient Care
provides expanded opportunity for the use of Medicare and private sector claims
data to drive higher quality, lower cost care
The Centers for Medicare &
Medicaid Services (CMS) today finalized new rules that will enrich the
Qualified Entity Program by expanding access to analyses and data that will
help providers, employers, and others make more informed decisions about care
delivery and quality improvement. The new rules, as required by the Medicare
Access and CHIP Reauthorization Act (MACRA), allow organizations approved as
qualified entities to confidentially share or sell analyses of Medicare and
private sector claims data to providers, employers, and other groups who can
use the data to support improved care. In addition, qualified entities may provide
or sell claims data to providers and suppliers, such as doctors, nurses, and
skilled nursing facilities among others. The rule also includes strict privacy
and security requirements for all entities receiving patient identifiable and
beneficiary de-identified analyses or data, as well as expanded annual
reporting requirements. For example, if entities receive patient identifiable
data or analyses, they must use protections that are at least as stringent as
what is required of covered entities and their business associates for
protected health information (PHI) under the HIPAA Privacy and Security Rules.
This initiative is part of a
broader effort by the Obama Administration to use data to help create a health
care system that delivers better care for patients, spends dollars more wisely,
and results in healthier people.
“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,”
said CMS Chief Data Officer Niall Brennan.
The Qualified Entity Program was
authorized by Section 10332 of the Affordable Care Act and allows organizations
that meet certain qualifications to access patient-protected Medicare data to
produce public reports. Qualified entities must combine the Medicare data with
other claims data (e.g., private payer data) to produce quality reports that
are representative of how providers and suppliers are performing across multiple
payers, for example Medicare, Medicaid, or various commercial payers.
Currently, 15 organizations have applied and received approval to be a
qualified entity. Of these organizations, two have completed public
reporting while the other 13 are preparing for public reporting. Additional
information on the qualified entity program can be found at the Qualified
Entity Certification Program website at https://www.qemedicaredata.org/SitePages/home.aspx.
Today’s rules seek to enhance the
current qualified entity program to allow innovative use of Medicare data for
non-public quality improvement and care delivery efforts while ensuring the
privacy and security of beneficiary information. For example, qualified
entities can conduct analyses on chronically ill or other resource-intensive
populations to increase quality and drive-down costs in the healthcare system.
The final rule contains few changes from the proposed rule. Future
rulemaking is anticipated to expand the data available to qualified entities to
include standardized extracts of Medicaid data. The final rule is on display at
the Office of the Federal Register at https://www.federalregister.gov/