CMS to drop price of Medicare provider data

The CMS will lower the planned price of Medicare provider data under a final rule issued today, after the regional groups that wanted the data to create quality reports complained that previously proposed prices would keep them from participating.

The final rule implements a program—authorized by the Patient Protection and Affordable Care Act—that allows qualified organizations to access patient-protected Medicare data and produce public reports on physicians, hospitals and other healthcare providers.

Such reports, according to the agency, would combine Medicare claims data with private-sector claims data to identify the physicians and hospitals that provide the highest quality, most cost-effective care to patients.

The changes in the final rule from the original rule proposed in June included a requirement that the provider data cost less than originally proposed for qualified entities.

Under the earlier proposed version, data for 2.5 million beneficiaries would have cost $200,000. The final design would lower the costs for the same number of beneficiaries to $40,000 for the first year and $32,000 for each subsequent year.

Other changes will give those organizations more flexibility in their use of Medicare data to create performance reports for consumers and extends the confidential review time of the data by healthcare providers, who may appeal any performance reports over inaccuracies before they are publicly released.

The final rule also includes privacy and security requirements and penalties for misuse that aim to protect patients, healthcare providers, and suppliers.

“We believe the sharing of Medicare data with qualified entities through this program and the resulting reports produced by qualified entities will be an important driver of improving quality and reducing costs in Medicare, as well as for the healthcare system in general,” regulators wrote in the final rule.