The feds’ decision to release Medicare claims data for quality measurement should help employers and individuals alike make more informed decisions down the road, advancing the goals of health care quality and value, a plan sponsor representative noted.
Importantly, the Centers for Medicare and Medicaid Services’ (CMS) final rules apparently will allow the selected data recipients to analyze this information on a provider-specific basis, said Kathryn Wilber of the American Benefits Council. “Having that transparency allows you to go to the next step — payment methodologies that are based on quality, and ultimately value.”
Under CMS’ rules, published Dec. 7 (76 Fed. Reg. 76542), the claims information will be released only to organizations that meet numerous requirements, involving privacy and security as well as methodology and inclusion of private plan data. Employers and consumer groups are among the “qualified entities” that CMS expects will participate in the program, which was mandated by the health reform law.
The final rules include many changes from the version CMS proposed in June. The revisions will make the data less costly for qualified entities and give them more flexibility in using it to create performance reports for consumers, but also extend the time period for health care providers to review and appeal reports before their release, CMS stated. Releasing any information on individual beneficiaries would be prohibited and subject to civil and criminal penalties.
HIPAA and other privacy restrictions that affect health benefits functions are covered in the Employer’s Guide to HIPAA Privacy Requirements.
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