ACO Rule Gives Patient Control Over Data Sharing

Centers for Medicare and Medicaid Services officials, in a final rule establishing the Medicare Shared Savings/ACO program, stuck to their guns on enabling beneficiaries participating in an ACO to opt-out of letting their claims data be shared.

"Although we have the legal authority, within the limits described previously, to share Medicare claims data with ACOs without the consent of beneficiaries, we nevertheless believe that beneficiaries should be notified of, and have control over, who has access to their personal health information for purposes of the Shared Savings Program," according to the final rule issued on Oct. 20. "Thus we proposed to require that, as part of its broader activities to notify patients that its ACO provider/supplier is participating in an ACO, the ACO must also inform beneficiaries of its ability to request claims data about them if they do not object."

And despite receiving comments that letting patients decline data-sharing runs counter to the goal of coordinated care and imperils ACO success, what CMS had proposed is pretty much what's in the final rule.

Beneficiaries should have some control over who has access to their health information in the Shared Savings program, the final rule states. "Furthermore, we believe that a beneficiary should not be subject to any penalties, such as being required to change their healthcare provider, if they decide that they do not want their information shared. The requirement that an ACO provider/supplier engage patients in a discussion about the inherent benefits, as well as the potential risks, of data sharing provides an opportunity for true patient-centered care and will create incentives for ACOs, ACO participants, and ACO providers/suppliers to develop positive relationships with each beneficiary under their care."

CMS, the rule notes, will monitor for any actions taken by an ACO to steer away patients who have declined data sharing.