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Quiet No More! CMS Calls for Comment on Release of Data

by Dan Haley, SVP and General Counsel

If you’re like me, you probably spend large chunks of time perusing health IT industry news, reading agency bulletins, and scrolling through esoteric Google alerts triggered by keywords like “EHR” and “ICD-10.” And you’re probably also aware that in early August, CMS issued a request for comment (RFC) on whether Medicare paid claims data should be made public. If you’re an ordinary person with an ordinary life, however, you probably missed it. And that is a shame because this is a hugely, massively, galactically important issue.

The deadline for comment is rapidly approaching — Friday, September 6th. athenahealth will submit a strong and unambiguous call for the liberation of CMS’s vast store of claims data and you should too. I’ll tell you why, but first some quick background:

  • In 1979, a federal appeals court issued an injunction barring the U.S. Department of Health and Human Services (HHS) from releasing most Medicare paid claims data.
  • Over the intervening three-plus decades, HHS and CMS have read that injunction broadly in support of a blanket policy that effectively treats nearly all of the government’s vast store of paid claims data as state secrets.
  • In May of 2013, a Federal District Court in Florida lifted the 1979 injunction, finally recognizing that, hey, the world has changed a bit in 30 years.

Just to be really clear, releasing claims data that could in any way identify patients never has and never will be on the table—that would be a huge violation of privacy. What we’re talking about is aggregated data that shows what physicians and hospitals were paid. There is nothing about specific patients.

CMS is asking for public comment on (a) whether paid claims data should be released; (b) under what restrictions it should be released; and (c) in what form it should be released. These days, there are plenty of big thinkers publishing an ongoing stream of material that extols the virtues of big data, and how it’s going to revolutionize the delivery of health care delivery. Yet in the midst of all this optimistic consensus, government continues to sit on a huge quantity of valuable information.

There are people within the government who “get it,” and they are gaining some traction. In recent months, HHS has released dribs and drabs of discrete data in small (tiny) sets. Senators Chuck Grassley (IA) and Ron Wyden (OR) proposed a bill this summer that would force CMS to liberate its data. But current policy remains as the CMS RFC acknowledges, that physician privacy concerns about the release of individual payments trumps the public interest in knowing how Medicare dollars are spent. That policy renders it impossible, in effect, to track and analyze Medicare payment patterns.

Why does that matter? Well, there’s general agreement’ that risk-based reimbursement and shared savings are the wave of the future, with fee-for-service is on the slow road to extinction. And what’s the single most important ingredient for successful sharing of risk and achievement of savings by care coordination? Bingo! Information!

Hang on, you say. Accountable Care Organizations (ACOs) and other shared savings entities can already access paid claims data for the patients served by their physicians. True enough. But not every physician is part of an ACO, so limiting who can look at this information limits the amount of savings our nation’s care providers are able to achieve.

But let’s take an even further view in the future. There are thousands of brilliant entrepreneurs waiting in basements and garages to develop the next big innovation that will transform health care, and access to this claims data will give them a bigger boost than any round of venture capital financing ever could.

Care coordination platforms hosted in the cloud (like our own athenaClarity) do a great job leveraging the limited data available to help physicians and health system leaders analyze their own patient patterns, coordinate care and realize savings. But—again—information is power. With a change in HHS’s policies, “Big Data” might finally realize its long-heralded potential to transform health care.

You have until September 6 to weigh in on CMS’s request for comment on the potential release of Medicare physician data. For whatever reason, the call for public comment was the equivalent of a whisper in an NFL stadium on game day. We’re doing our part to amplify that call. This is a hugely important issue. Make your voice heard. Comment today.

Check out Dan Haley's Google+ Profile. Follow @DanHaley5 on Twitter.

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