Improving Health Care by the Public Disclosure of Private Information

The Centers for Medicare & Medicaid Services (CMS) last week proposed regulations designed to help patients choose better-quality health care at more affordable prices. These new rules will permit the public disclosure of certain Medicare data so that it can be compiled into reports on physicians, hospitals and other health care providers. These reports will attempt to identify how good providers really are, and how much they charge.

Part of the Patient Protection and Affordable Care Act, these new regulations will promote transparency, according to CMS Administrator Donald M. Berwick, M.D. He explained: ”Making more Medicare data available can make it easier for employers and consumers to make smart decisions about their health care. Performance reports that include Medicare data will result in higher quality and more cost effective care. And making our health care system more transparent promotes competition and drives costs down.”

These new regulations will hopefully help patients and employers understand more about health care in their community as it provides the following:

  • CMS would provide standardized extracts of Medicare claims data from Parts A, B, and D to entities that qualify to receive this data.  In theory, this data can only be used to evaluate performance so it can be produced in a report for the public.
  • The data provided to the qualified entity will cover one or more specified geographic area(s).
  • The qualified entity would pay a fee that covers the federal government’s cost connected with the enforcement of these regulations.
  • To prevent mistakes, the regulations require qualified entities to share the reports confidentially with providers prior to public release.
  • Publicly released reports will never contain individual patient information, but rather reports in the aggregate.

These proposed regulations are part of the Hospital Value-Based Purchasing initiative designed to reward hospitals for better quality of care and greater efficiencies with respect to Medicare. The proposed rules will also permit Medicare to pay new Accountable Care Organizations (ACOs) for improvement.

The full text of the proposed regulations can be viewed HERE.