CMS releases rule to extend access to Medicare information

The CMS (Centers for Medicare and Medicaid Services) on the day of Friday released final rules covering increased approach to analyses and information that will assist contributors, employers and others make more informed decisions about quality improvement and care delivery.

The new rules, needed as a provision of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), are meant to augment the Qualified Entity Program, proposed by the Affordable Care Act, which authorizes the qualified entities confidentially share or sell analyses of Medicare and private sector claims information to contributors, employers and other groups that can utilize the information to support better care.

For instance, CMS claims provisions of the rule enables qualified entities to perform analyses on information from chronically sick or other resource-intensive sufferer populations to increase quality and drive down healthcare prices.

Moreover, under the rules, qualified entities might offer or sell claims information to contributors and suppliers, like physicians, nurses and skilled nursing services, among others.

“Increasing approach to analyses and information that involve Medicare data will make it convenient for stakeholders throughout the healthcare system to make smarter and more informed healthcare decisions,” stated Niall Brennan, chief data officer at CMS, in a written statement.

Although, the agency points out that qualified entities must combine the Medicare information with other claims information—like private payer information—to “produce quality reports that are representative of how contributors and suppliers are performing across various payers—for instance Medicare, Medicaid or several commercial payers.”

Further, CMS forced that making sure the privacy and security of beneficiary data is of paramount significance, and that the new rules involve strict privacy and security needs for all entities that get sufferer identifiable and beneficiary de-identified analyses or information.

“For instance, if entities get patient-identifiable data or analyses, they must utilize protections that are at least as stringent as what is needed of covered entities and their business associates for protected health data under the HIPAA Privacy and Security Rules,” claimed the agency.

Although, Deborah Peel, MD, founder and president of the agency Patient Privacy Rights, asserts that this new rule is morally and ethically not right.

“CMS knows that the public has never encouraged research without meaningful consent, which breaches the Common Rule and post-World War II ethics. But worse, it is a worst decision because putting control of Medicare and Medicaid (protected health data) into the hands of close to a million hidden information brokers will make sure the greatest harms to the most vulnerable and supports present HIT giants whose technology must change to end harms to sufferers,” states Peel, an advocate for patients’ rights to control the utilization of personal health data in electronic systems.

“Paper medical records systems all required consent for any health data to be shared with any other doctor, except in rare emergencies,” she further adds. “Paper records never caused such extreme hidden harms. Government’s job is to facilitate and protect persons, not corporations. HHS has betrayed U.S. sufferers.”

In its announcement, CMS pointed out that the final rules consist of few changes from its original proposed rule and that “future rulemaking is hoped to extend the information available to qualified entities to involve standardized extracts of Medicaid information.”

To date, fifteen agencies have applied for and got approval to be a qualified entity; of those, two have completed public reporting, while the other thirteen are preparing for public reporting.