BREAKING: Medicare Data Allowed to Be Used for Doctor, Hospital Report Cards

The Centers for Medicare and Medicaid (CMS) announced that qualified employers, insurance groups, and consumer groups will be able to utilize Medicare data to create report cards to measure the quality standards of physicians and hospitals, pursuant to Section 10332 of the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148). CMS stated that by allowing qualified entities to access its claims database, these organizations could identify high quality providers and assist consumer decision-making with online tools, increasing transparency and accountability in the health care system. Marilyn Tavenner, Acting CMS Administrator, stated, “This provision of the health care law will ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar.”

The final rule contains changes from the original proposed rule, including stringent requirements regarding the privacy of patient data. The database contains information regarding approximately 47 million beneficiaries and every participating physician and hospital. Pursuant to a request by the American Medical Association, CMS will evaluate the analytical methods proposed by groups wanting to use the data, before they are given access. Additionally, the organizations must pay an access fee and meet other requirements to qualify.