CMS unleashes bigger trove of claims data to help hospitals improve care quality

New rules under MACRA mean that qualified providers can share or sell analyses of Medicare and private claims data, which the Centers for Medicare and Medicaid Services could be a boon to better care delivery.
By Bernie Monegain
10:48 AM
CMS claims data

The Centers for Medicare and Medicaid Services is making more claims data and analyses available to help care providers, employers and others boost the quality of care across the country.

The goal is to help organizations and individuals make better informed decisions about care delivery and quality improvement.

The new rules required by the Medicare Access and CHIP Reauthorization Act, or MACRA, allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups that can use the data to support improved care.

“Medicare data will make it easier for stakeholders throughout the healthcare system to make smarter and more informed healthcare decisions,” CMS Chief Data Officer Niall Brennan said in a statement.

The Affordable Care Act authorized the Qualified Entity Program, which allows organizations that meet certain qualifications to access patient-protected Medicare data to produce public reports.

Qualified entities must combine the Medicare data with other claims data – private payer data, for example – to produce quality reports that are representative of how providers and suppliers are performing across multiple payers.

To date, 15 organizations have applied and were approved as qualified entities, CMS noted. Of these organizations, two have completed public reporting while the other 13 are in the preparation stage.

CMS officials said that future rulemaking is expected to expand the data available to qualified entities to include standardized extracts of Medicaid data. 

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