Proposed CMS rule encourages analysis, sharing of medical-claims data

(Story updated at 12:30 p.m. Eastern)

Some medical data miners may soon be allowed to share and sell Medicare and private-sector medical-claims data, as well as analyses of that data, under proposed regulations the CMS issued Friday.

Quality improvement organizations and other “qualified entities” would be granted permission to perform data analytics work and share it with, or sell it to others, under an 86-page proposed rule that carries out a provision of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The analyses could be given or sold “to providers, employers, and other groups who can use the data to support improved care,” according to a CMS news release. Qualified entities would also be allowed to provide or sell the actual claims data to providers, the 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,” said CMS Acting Administrator Andy Slavitt in the news release.

Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value in Appleton, Wis., said the MACRA provision would allow organizations like the Wisconsin Health Information Organization to accept Medicare data and then publicly report the performance of physicians both on cost and quality. The information exchange, one of the original 13 qualified entities, is the all-payer claims database for the state.

"This is going to allow us to get down to the nitty gritty of best practices, who is doing what, and what works and doesn't work," Toussaint said. "I think that's a pretty big change.”

So far, 13 organizations have applied for and received approval to become a qualified entity under the act's provisions.

Several states already have commercial claims in their databases, and the addition of Medicare claims will give them a view of “most of the episodes of treatment that physicians deliver,” Toussaint said.

That will fuel more public reporting of how individual physicians perform. "If there's a physician in Florida who is twice as expensive and has a lot of readmissions," Toussaint said, "that person is going to be compared to the physician who's half as expensive with fewer complications."


Joseph Conn

Joseph Conn reports on information technology, privacy and data security. He has been a reporter and editor for 35 years for various news publications and taught journalism at Valparaiso (Ind.) University, where he earned his bachelor's degree in English. He also worked as a Peace Corps volunteer in Sierra Leone. Conn joined Modern Physician in 2000, serving as reporter, editor and online editor. He joined Modern Healthcare in 2005.

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Sabriya Rice

Sabriya Rice reports on quality of care and patient-safety issues. Rice previously wrote and produced for the medical unit of CNN, where she contributed to the Empowered Patient column and the weekly medical program formerly called “Housecall with Dr. Sanjay Gupta.” She earned a bachelor's degree in film and television from the University of Notre Dame and a master's in communication studies from the University of Miami in Coral Gables, Fla. She joined Modern Healthcare in 2014.

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