CMS will create ACO claims, provider database

The Centers for Medicare and Medicaid Services will create a database containing the health information of Medicare beneficiaries who receive treatment with providers participating in an accountable care organization.

CMS said it will use the data collection to support policy activities and reimbursement for its programs to bundle payments and share savings.

Besides Medicare beneficiaries, the database will contain personally identifiable information about certain individuals participating in the ACOs, including healthcare sole proprietors, providers, key leaders and managers of ACOs and contact persons.

Some of the information could be patient claims number, which could incorporate a Social Security Number, address and date of birth, or ACO eligibility and contact records, including the home address of a key leader or manager; or ACO participant tax identification number, according to an announcement in the Sept. 19 Federal Register. The database will become effective Oct. 19. The public may comment on it until then.

Federal agencies must report when they intend to establish a new system with personally identifiable information and assure safeguards against its disclosure for other than its stated uses, including determining the eligibility of ACO applicants, to meet quality and other reporting requirements, under the Privacy Act.

“Relevant HHS personnel, and any CMS contractors, grantees and consultants assisting them, will use personally identifiable information from this system on a ‘need to know’ basis,” the notice said.

The Medicare Shared Savings Program aims to reward quality care and takes steps toward paying for quality and efficient care by promoting accountability for a patient population and coordinates inpatient and ambulatory services and encourages investment in health IT and redesigning care processes. Under the Pioneer ACO Model, up to 30 provider organizations will test alternative payment models that include escalating financial accountability and arrangements based on outcomes in quality and patient experience.

The programs are designed to carry out new delivery and reimbursement provisions under the Patient Protection and Affordable Care Act.