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Data on care you provide could become public under proposed rule


The Centers for Medicare and Medicaid Services (CMS) wants to publicize data about the care you?re providing as a primary care physician so that consumers and business could compare your cost and quality to other providers. The claims data would be derived from both Medicare and private sector insurers. Find out more while there?s still time to influence the final rule.

Get ready for the latest performance reports that purport to help demonstrate the quality and cost-effectiveness of the care you’re providing as a primary care physician.

On June 8, the Centers for Medicare and Medicaid Services (CMS) published proposed rules in the Federal Register that would give consumers and employers data about local physicians, hospitals, and other healthcare providers-data based on claims and intended to help them select those who deliver higher quality and at lower cost. The claims data will be derived from both Medicare and private sector insurers.

CMS says the initiative is part of a broader effort by the Obama administration under the Affordable Care Act to improve care and lower costs. The reports are a response to criticism that, up until now, healthcare claims data have been limited and piecemeal, according to CMS. As a result, many health plans have been forced to create provider performance reports based only on their own claims, which may represent only a small portion of a provider’s overall practice.

Under the new performance report program:

• CMS would provide standardized extracts of Medicare claims data from Parts A, B, and D, only to qualified entities. The data can be used only to evaluate performance and to generate public reports.

• Data would cover one or more specified geographic area(s).

• Qualified entities would pay a fee to cover CMS’s cost of making the data available.

• To receive the Medicare claims data, qualified entities would need to have claims data from other sources. It is CMS’s position that combining claims data from multiple sources creates a more complete and accurate picture about performance.

• Qualified entities would share the reports they compile confidentially with providers prior to public release, giving the opportunity for review and correction, if necessary.

• Publicly released reports would contain aggregated information only, meaning no individual patient/beneficiary data would be shared or be available.

• Qualified entities would have to apply for the program and demonstrate their capabilities to govern the access, use, and security of Medicare claims data.

• CMS would continually monitor qualified entities; those not following procedures would be subject to sanctions and possible termination from the program.

CMS is inviting comments on the proposed rules until August 8. You can submit comments electronically at, referencing file code CMS-5059-P.

Speak now or forever hold your claim.

Go back to the current issue of eConsult.

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Jennifer N. Lee, MD, FAAFP
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