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 CMS regulations.
Quality improvement organizations and other “qualified entities” could perform data analytics work and share it with, or sell it to others, under a provision of the Medicare Access and CHIP Reauthorization Act of 2015.
Their analyses could be given or sold “to providers, employers and other groups who can use the data to support improved care,” according to the CMS. Qualified entities would also be allowed to provide or sell the actual claims data to providers.
Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value in Appleton, Wis., said the provision would allow organizations such as the Wisconsin Health Information Organization to accept Medicare data and then publicly report physicians' performance on cost and quality. The information exchange is the state's all-payer claims database. “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,” he said.
So far, 13 organizations have applied for and received approval to be 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.