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Guess Who'll Soon Have Your Data?

June 20, 2011
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A new CMS proposed rule will soon fling the doors wide open on Medicare claims data

Still think consumers are completely in the dark about clinical outcomes? Well, if you’re thinking about the average healthcare consumer as an individual, certainly there’s room for debate. But if you’re thinking of some of the healthcare consumer alliances popping up across the spectrum of interests and activities in the industry, it’s time to wake up and smell the coffee.

On June 3, the Centers for Medicare and Medicaid Services (CMS) announced a new proposed rule that would give some non-provider, non-payer organizations access to Medicare claims data for purposes of data mining in order to engage in outcomes analysis. “Making more Medicare data available can make it easier for employers and consumers to make smart decisions about their healthcare,” CMS administrator Donald M. Berwick, M.D., said in a statement announcing the rule’s release. “Performance reports that include Medicare data will result in higher-quality and more cost-effective care. And making our healthcare system more transparent promotes competition and drives costs down,” he added.
Those organizations that CMS would deem as qualified to engage in such activity would be required to incorporate private claims data with the data from the Medicare program when developing reports.

So what kinds of organizations have been pounding on CMS’ door for such data access? One is Consumers’ Checkbook, a consumer service ratings group based in Washington, D.C., which had in 2006 unsuccessfully sued the federal government for access to Medicare claims data. Consumers’ Checkbook rates such consumer goods and services as automobiles, local moving companies, plumbers, roofers, and electricians; furniture and carpeting stores, florists, supermarkets, and such; and hospitals, doctors, and dentists, in seven different metro areas across the country.
Want to have your carpet cleaned? Consumers’ Checkbook will tell you which carpet cleaning services provide the best value.

Want to get information on hospital quality? Consumers’ Checkbook compares mortality and “adverse outcome” rates “for major types of cases.” And it provides “desirability scores” for various types of surgery, “complex adult medical care,” and maternal delivery, among other areas.

What’s more, The Wall Street Journal is currently involved in a lawsuit attempting to force the federal government to provide access to identifiable doctor records in the Medicare database. The WSJ’s reporters want to be more effective in investigating potential reports of Medicare fraud.

Here’s what’s interesting about all this: over the next decade, healthcare providers can expect the drive for healthcare quality transparency to intensify over time, meaning that patient care outcomes will only become more available to more kinds of people and organizations than ever.

This is something that provider leaders should consider very carefully. Does anyone really think that those hospital and medical group organizations whose leaders choose to decline to participate in the emerging accountable care organization (ACO) program; who are dragging their collective heels on developing the infrastructure for outcomes quality reporting for meaningful use; who shy away from participating in local-market pay-for-performance initiatives—will be able to hide in the dark much longer?

It’s time to brand such thinking for what it increasingly is—delusional. If Consumers’ Checkbook will soon have access to your Medicare claims data, can extreme transparency be far behind? I think not. The good news is that those patient care organizations whose leaders are willing to plunge into the deep end of the pool on the transparency issue will be rewarded. Just make sure your organization’s leaders aren’t left clinging to the ledge on the shallow end going forward.