Hospitals want health insurance plans to give up more patient information before they can get access to Medicare and private sector claims data. The CMS should also release data from Medicaid and the Children's Health Insurance Program.
In February, the CMS proposed a rule aimed at expanding access to analysis and data that could help healthcare industry stakeholders make business decisions that reduce costs and improve quality of care. Comments on the rule are due tomorrow.
The Medicare Access and CHIP Reauthorization Act requires Medicare and private sector claims data be made available to "qualified entities” that could confidentially share or sell the information to providers, employers, plans or anyone else who can use that data to improve care.
MACRA mandates that a qualified entity may not provide or sell non-public analyses to an insurer unless that issuer provides the entity with claims data, but the law does not specify a minimum amount of data that the issuer must provide.
The CMS suggested that a plan provide the entity with claims data that represent a majority of the issuer's covered lives in the geographic region and during the time frame covered by the non-public analyses that the issuer has requested.
In a letter, the American Hospital Association presents an example (PDF) of how the current proposal would work. In their scenario, an issuer requesting non-public data in Minnesota for the first six months of 2015 would need to provide the entity with data on at least 50% of the issuer's covered lives in the state for that same time period.
The AHA believes that the threshold of a mere majority of the issuer's covered lives is too low. Instead, the CMS should require an entity to provide or sell non-public analyses to an issuer only after it has provided the entity with data on 100% of its covered lives for the geographic region and during the time frame of the non-public analyses requested by the issuer.
Granting the entity access to all of a plan's covered lives in the same region would allow for better care coordination and quality assessment and improvement, the AHA said.
The trade group also believes that entities should be able to access Medicaid and Children's and Health Insurance Program (CHIP) beneficiary data.
So far, 13 organizations have applied for and received approval to become a qualified entity under the act's provisions. OptumLabs, the research collaborative, is among them. Others include not-for-profit health data organizations and state health departments.
If the proposal is finalized, the CMS estimates the number of qualified entities will go up to 20.
The CMS said it has gotten 15 comments on the rule thus far, but it's only posted five of them as of Monday.
The MACRA provision takes effect on July 1, 2016, so the CMS would have to issue a final rule before then.