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Hospital Report

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The premier resource for hospital professionals from Relias Media, the trusted source for healthcare information and continuing education.

CMS to allow claims data to be used for performance measurement

January 12th, 2015

A final rule published today in the Federal Register will give employers, consumer groups, and insurance companies access to information from Medicare’s vast claims database that could be used to rate physicians’ performance in greater detail than previously possible.

According to the rule on Availability of Medicare Data for Performance Measurement, the data will identify physicians but not specific patients, and “strong penalties will be in place for any misuse of data.”

The claims database has always been off-limits for this sort of thing, forcing insurers to make assessments based on their own, much more limited claims data, but the Affordable Care Act changed all that.

In a press release, acting CMS administrated Marilyn Tavenner trumpeted the new rule: “This is a giant step forward in making our health care system more transparent and promoting increased competition, accountability, quality and lower costs. 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.”

What remains to be seen is what use ordinary health care consumers actually will be able to make of the new data. After all, transparency’s been on the rise for years, and it’s still not clear whether public reporting has had any significant effect on how people choose their providers. That may be because much of the publicly available data hasn’t been publicized very well, but it may also be that much of the data simply goes over people’s heads. Given the degree of statistical illiteracy in this country, the only way many consumers could make sense of data derived from the claims database would be to rely on second-hand “report cards” created by private insurers, employers or consumer groups, any of which might be based on flawed or even biased reasoning.

I’m all for transparency and for health care consumers having access to the most accurate and comprehensive performance data available, but isn’t it just as important to educate ordinary citizens on how to effectively interpret data for themselves?