A new rule from the Centers for Medicare & Medicaid Services (CMS) would extend access to CMS claims data to support quality improvement efforts. But the increased access to personally identifiable claims—including to for-profit companies—may pose privacy risks for patients.
The rule, released July 1, 2016, will allow organizations that the CMS has certified as “qualified entities” to share or resell CMS claims data analyses to clinicians, health care organizations, or other organizations, including for-profit ones, to be used for quality improvement efforts. The new rule also outlines privacy and security requirements for the organizations receiving patient-identifiable or de-identified data.
“Increasing access to analyses and data that include Medicare data will make it easier for stakeholders throughout the healthcare system to make smarter and more informed healthcare decisions,” said CMS Chief Data Officer Niall Brennan in a press release.
For example, CMS noted that qualified entities could analyze the care received by chronically ill populations to boost quality and possibly drive down the cost of care for these individuals. This might be particularly useful in improving care for patients with chronic kidney disease (CKD) or end stage renal disease. Patients with CKD now make up about 10 percent of the Medicare population, but account for about 20% of Medicare costs, according to an analysis from the United States Renal Data System (http://bit.ly/29ODoit).