AHA Looks Through Congress Towards CMS, Urges Transparency

The American Hospital Association (AHA) wrote a letter encouraging members of the Senate to increase access to health care data while maintaining patient privacy and the security of patient information. The letter seeks to uncover the currently unavailable wealth of CMS data, which AHA says can be used to improve upon the quality and value of health care. Through measures that are targeted at CMS, AHA believes data sets can be made into accessible, practical, and efficient tools for research and progress.

Data

The letter focuses on Medicare claims data that CMS, at present, makes only partially available. AHA recommends that CMS be required to make data from across the continuum of care accessible, so that opportunities for improvement in the quality of care can be identified for the whole continuum of care. To effectuate that goal, AHA says that the Part B Carrier and the Part B Durable Medical Equipment limited data set (LDS), the standard analytic files (SAF), and the Part D prescription drug data should be made accessible to interested parties and researchers. Part of the AHA recommendation is to have CMS streamline current practices. For example, AHA suggests that the access to research identifiable files (RIFs) be simplified from the current system, which requires a review board approval for each project, to a system where researchers are granted a “one-time clearance” from the review board for a specified period of time.

Transparency

The AHA also expresses in the letter its support for initiatives to improve price and quality transparency among providers. For example, the letter indicates AHA’s support for the Health Care Price Transparency Promotion Act (H.R. 1326), which would impose a requirement on states to have or establish laws requiring hospitals to disclose price data for certain services.As part of its involvement in a Healthcare Financial Management Association (HFMA) report, which the AHA attached to its letter, the AHA identified that health plans are best situated to pass along pricing data to insured patients. In keeping with that understanding, the letter recommends to congress that health plans should be the primary source of pricing information for insured patients. AHA also recommends that CMS publish additional quality data while maintaining awareness about the comparative usefulness and relevance of the data it provides.

Caution

In a separate section, the AHA sets out several cautionary statements regarding the need for prudence as data access grows. The letter emphasizes that “caution must be exercised to ensure privacy and security is maintained.” The AHA letter includes a reminder to congress that de-identified data can be reconnected to individuals with relative ease. In light of the ease of extrapolating protected information from health care data, the letter urges congress to exercise a heightened level of caution when considering making information available to entities that are not considered covered entities under the Health Insurance Portability and Accountability Act (HIPAA) (P.L. 104-191).