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Medicare data and measuring provider performance

It's becoming more and more important that organizations reporting provider performance have access to the Medicare data. The Center for Medicare Services is working on this and the following is an update on where they are at.
CMS data experts are working feverishly to comply with Section 10332 of the affordable care act. This requires that by 2012 "Qualified Entities" will be able to access the medicare data. But this has never been done before so new regulations are being written regarding HIPPA compliance, Data use agreements, Business Associate Agreements which allow entities to exchange personal health information, and other important issues. The Center has been working with CMS administrators on these issues and others and they have been listening. In the last six years The Wisconsin Health Information Organization(WHIO) has solved many of the problems CMS is now struggling with. The good news is these officials are engaged and very interested in what we have learned which may allow them to write the regulations in a way that WHIO can receive this data and integrate it with the rest of the nearly 4.2 million residents that already exist in the data base. The following is a summary of what CMS is working to do in section 10332. Section 10332 of the Affordable Care Act
  • Requires that the Secretary make data available to qualified entities for the evaluation of performance of providers of services and suppliers
·         Qualified entities are defined to be a public or private entity that (1) is qualified to evaluate the performance of providers on measures of quality, efficiency, effectiveness, and resource use; and (2) agrees to meet the requirements specified by the Secretary
  • Data includes the standardized extracts (as determined by the Secretary) of claims data under Parts A, B and D for items and services for one or more geographic areas and time periods as requested by the qualified entity
  • The Secretary is required to take the necessary actions to protect the identify of beneficiaries
  • Data is made available to the qualified entity at a fee equal to the cost of making the data available
  • Uses and Methodologies.
The qualified entity must: ·         Submit to the Secretary a description of the methodologies the entity will use to evaluate the performance of providers of services and suppliers using such data ·         Use certain measures, as specified by the Secretary ·         Include data from other sources, besides Medicare ·         Only include information on the evaluation of performance of providers and suppliers in reports required by this section ·         Submit reports to the Secretary prior to releasing the data Reports of data under this section must meet certain requirements: ·         Include a description of the measures ·         Be made available confidentially to any provider or supplier identified in the report, prior to public release of the report, and provide an opportunity to appeal and correct errors ·         Only include information on a provider of services in aggregate form, as determined by the Secretary ·         Be made available to the public The entity must agree to release the information on the evaluation of performance of providers and suppliers. Effective date: Jan. 1, 2012

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