A new Medicare effort to expand the availability of its data sets—and allow organizations to sell analyzes of that data--also should increase the number of organizations authorized to use the information.

In recent years, CMS has made data sets available to “qualified entities” in its Medicare Data Sharing for Performance Measurement Program, covering home health, durable medical equipment and hospital/physician utilization and payment rates, as well as prescription drug prescribing and patient cost patterns, among other information. Thirteen organizations have applied and been approved to be a qualified entity.

Now, CMS is going further, enabling not just use of its data but the selling of analyses based on the data. Data sold may not include protected health information.

Stanley Nachimson
Stanley Nachimson

The expectation of CMS in the proposed rule is that the number of qualified entities will significantly increase if the data sets are expanded and organizations have opportunities to commercialize their analyses of the information, says , says Stanley Nachimson, a former Centers for Medicare and Medicaid Services official and now a consultant..

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Under the proposed rule, qualified entities would be permitted to access Medicare data to produce public reports that also could include private payer data “to produce quality reports that are representative of how providers and suppliers are performing across multiple payers,” according to an agency statement.

“This proposed rule would explain how qualified entities may create non-public analyses and provide or sell such analyses to authorized users, as well as how qualified entities may provide or sell combined data, or provide Medicare claims data alone at no cost, to certain authorized providers,” the rule states.

Under the rule, the expanded streams of data made available would support quality assessment and improvement activities, care coordination, review of provider/supplier performance, fraud/waste/abuse detection, and compliance purposes. Use of the data for marketing purposes is prohibited.

The expansion of Medicare data availability was authorized under the Medicare Access and CHIP Reauthorization Act of 2015, but CMS previously has been making available standardized extracts of Medicare Part A and B claims data and Part D drug event data under provisions of the Affordable Care Act.

The proposed rule, available here, includes a comment period ending March 29, 2016. A list of the current 13 Qualified Entities for data sharing is here.

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