FOR IMMEDIATE RELEASE Contact: CMS Media Relations
November 21, 2012 (202) 690-6145
Medicare continues effort to give consumers more information on health care quality
Today, the Centers for Medicare & Medicaid Services (CMS) announced the first three participants in a program designed to help consumers get more information regarding their local doctors, hospitals, and other health care providers. The Medicare Data Sharing for Performance Measurement program, made possible by the health care law, makes Medicare claims data available, under strict privacy requirements, to groups that HHS certifies as qualified to handle this data and protect patient privacy. These groups will combine Medicare and private insurance data to create comprehensive, useful reports on provider performance.
The three organizations announced today, are:
- Health Improvement Collaborative of Greater Cincinnati
- Kansas City Quality Improvement Consortium (serving the Greater Kansas City area in Missouri and Kansas)
- Oregon Health Care Quality Corporation
“These organizations will make quality and cost information more available and easier to understand for the health care systems in their areas,” said Acting CMS Administrator Marilyn Tavenner. “By allowing these organizations to combine Medicare data with other insurers’ data in public reports, consumers and businesses will have better information on provider performance and providers will have a greater incentive to improve the quality of care.”
To receive certain Medicare claims data, organizations participating in the program must show that they can manage and process consumer-focused data and can prevent breaches of protected health information. The organizations must also show that they are working with private insurers to access other payer data in order to produce comprehensive reports on provider performance.
The program takes important steps to protect the privacy of patients. Information that could identify specific patients will not be publicly released and strong penalties will be in place for misuse of the Medicare data.
With access to provider performance reports, employers and consumer organizations can identify and reward high quality health care providers in their local areas and develop online tools to help consumers and their families make health care choices informed by this useful data.
For more information on CMS’ Qualified Entity Program, visit:
Qualified Entity ProgramSection 10332 of the Affordable Care Act amends section 1874 of the Social Security Act (the Act) by adding a new subsection (e) requiring standardized extracts of Medicare claims data under parts A, B, and D to be made available to ‘‘qualified entities'' for the evaluation of the performance of providers and suppliers. Qualified entities may use the information obtained under section 1874(e) of the Act for the purpose of evaluating the performance of providers and suppliers, and to generate public reports regarding such performance.
Potential qualified entities that wish to request data under this provision must submit an application that includes, among other things, a description of the methodologies that the applicant proposes to use to evaluate the performance of providers and suppliers in the geographic area(s) they select. Once certified, qualified entities:
• enter into a Data Use Agreement committing the organization to the highest levels of data security and privacy protection;
• pay a fee equal to the cost of making the data available;
• receive data for one or more specified geographic areas;
• combine claims data from sources other than Medicare with the Medicare data.
• use valid and reliable measures for evaluating the performance of providers and suppliers; and,
• produce and make publicly available reports on individual providers and suppliers in aggregate form.
We believe the sharing of Medicare data with qualified entities through this program and the resulting reports produced by qualified entities will be an important driver of improving quality and reducing costs in Medicare, as well as for the health care system in general. Additionally, we believe this program will increase the transparency of provider and supplier performance, and provide beneficiaries access to information that will help them make more informed decisions about their health care.
For more information on or to apply for the Qualified Entity Program, please visit the links below.