CMS Issues Final Rule Allowing Organizations To Access Claims Data

On Monday, CMS announced a final rule allowing qualified organizations to access its claims database to develop public ratings reports on physicians, hospitals and other health care providers, Modern Healthcare reports (Daly, Modern Healthcare, 12/5).

Background

According to the AP/Washington Post, the database is considered the "mother lode" of health care data, with information on 47 million beneficiaries and nearly every participating physician and hospital in the country.

However, access to the database largely has been prohibited because of a longstanding court decision protecting the privacy of physicians. A provision in the federal health reform law altered federal law to allow for access to the data (AP/Washington Post, 12/6).

Details of Final Rule

Interested parties still will have to pay to access the data. According to Modern Healthcare, the final rule reduces the cost of the data per 2.5 million beneficiaries from $200,000 in the proposed rule to $40,000 for the first year and $32,000 each subsequent year.

Under the final rule, qualified organizations have more flexibility in how they use the data to develop performance reports and the amount of time health care providers -- who may appeal the reports -- can review the data before they are released to the public. The final rule also includes various privacy and security requirements, in addition to penalties for misuse of the data (Modern Healthcare, 12/5).

The billing records will help experts determine how well physicians perform specific procedures and how often their work causes preventable complications, the AP/Post reports (AP/Washington Post, 12/6). According to CMS, those experts would combine the data with private-sector claims data to rank health providers by the quality and cost-effectiveness of their care (Modern Healthcare, 12/5).

Reaction

CMS Acting Administrator Marilyn Tavenner said the new policy is "a giant step forward in making our health care system more transparent and promoting increased competition, accountability, quality and lower costs."

David Lansky, president of the Pacific Business Group on Health, said, "There is a tremendous variation in how well doctors do, and most of us as patients don't know that. We make our choices blind." He said, "This is the beginning of a process to give us the information to make informed decisions."

Some consumer groups criticized the provision allowing providers to review the data before it goes public, saying that could make it difficult to produce ratings (AP/Washington Post, 12/6).

Hamburg Says Regulators, Drugmakers Should Release Confidential Data

In related news, FDA Commissioner Margaret Hamburg on Monday said that regulators and drugmakers should release confidential drug data in order to expose vital information about fighting diseases, Reuters reports.

Hamburg said that releasing the data must be done selectively. However, she said, "There are, if you look at the big picture, huge opportunities to open some of that data from greater analysis and provide broader benefit to our understanding of the science of these products."

For example, releasing detailed data on how experimental drugs performed in clinical tests could prevent scientists from pursuing ineffective courses of research, she said (Hirschler, Reuters, 12/5).