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    American Urological Association, others protest Centers for Medicare & Medicaid Services plan to sell claims data

    Information would be used to rate physician performance

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    Bob Gatty
    Washington—Physician organizations nationwide, including the AUA, have united in opposition to many provisions of a plan by the Centers for Medicare & Medicaid Services to sell Medicare claims data to qualified businesses that would generate public reports rating physician performance in each episode of care.

    The rule, announced in June by CMS, stems from the Affordable Care Act and is intended, CMS said, to improve care and lower costs.

    "Making more Medicare data available can make it easier for employers and consumers to make smart decisions about their health care," said CMS Administrator Donald M. Berwick, MD, in announcing the proposed regulation.

    The new program would provide for the following:

    • CMS would provide standardized extracts of Medicare claims data from Parts A, B, and D to qualified entities (QE), the organizations that would develop and make public the reports. The data can only be used to evaluate provider and supplier performance and to generate the reports.
    • The data provided to the QE would cover one or more specified geographic area(s).
    • The QE would pay a fee that covers CMS's cost of making the data available.
    • To receive the Medicare claims data, QEs would need to have claims data from other sources.
    • To prevent mistakes, QEs must share the reports confidentially with providers prior to their public release to give them an opportunity to review reports and provide necessary corrections.
    • Publicly released reports would contain certain aggregated information only. No individual patient/beneficiary data would be shared or be available.
    • During the application process, QEs would need to demonstrate their capabilities to govern the access, use, and security of Medicare claims data. They would be subject to "strict security and privacy processes," CMS said.
    • CMS said it would continually monitor QEs, and those that do not follow procedures would risk sanctions, including being kicked out of the program.

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    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

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