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CMS Progress Towards Greater Data Transparency

Tuesday, August 6, 2013

The following is a cross-post by Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services (CMS), and Niall Brennan, Director of the Office of Information Products and Data Analytics at CMS and cross posted from the HealthData.gov Blog.

Over time it has become very clear that health care today relies on sharing data to drive improvements in access and care delivery as well as control costs.  The Centers for Medicare and Medicaid Services (CMS) has embraced the need for greater data transparency while recognizing the importance of appropriately protecting personally identifiable information (PII).

Five years ago, CMS began to actively explore opportunities to provide new avenues for accessing data in order to make data available to a broader group of users.  We are proud to say that today we are routinely and safely sharing data to support the transformation of the delivery system.

Sharing data with providers

We are developing a broader strategy for providing more data to providers for performance measurement and quality improvement.  For example, CMS is:

  • Helping to promote efficiency in performance measurement through the qualified entity (QE) program.  This program creates a structure through which providers can receive a single, actionable report covering all or most of their practice.  QEs combine Medicare claims data from CMS with claims data from other payers to create comprehensive reports on the performance of hospitals, physicians, and other health care providers.
  • Providing Accountable Care Organizations (ACOs) with monthly claims feeds covering the almost 3 million beneficiaries being cared for by physicians participating in the ACOs.  The monthly feeds include care the beneficiary receives from both providers participating in the ACO and those that do not participate.  These data permit the ACO to coordinate care for beneficiaries and provide true patient-centered care in a fee-for-service system.
  • Working to improve the performance reports that providers currently receive from CMS to ensure that they are as meaningful as possible.  An example of such a report is the Quality and Resource Use Reports released to physicians and physician groups.
  • Developing a strategy for providing more data to more providers for performance measurement and quality improvement as required by the American Taxpayer Relief Act of 2012.

Providing Medicare data through Blue Button

CMS has also allowed beneficiaries full and open access to their Medicare claims data through the Blue Button Initiative.  With Blue Button, Medicare beneficiaries can easily and securely download three years of Medicare Parts A, B and D data in a simple format.  Beneficiaries can then share this data with providers and caregivers through tools such as smartphone apps.

Making data available to researchers

In addition, CMS is supporting an increasing number of researchers interested in using CMS data to conduct research to improve the healthcare system.  Since 2009, the number of research data requests we have supported has increased by nearly 300 percent.  We’ve also reached out to non-traditional researchers, such as innovative data analytics companies, to learn more about their data needs. By making the data more available, we hope to inspire users to use data in new and innovative ways that will help in our shared goal of transforming the health care system.

Maximizing data’s potential.  In the last year, CMS has also strived to make more program data available in multiple formats to spur innovation and let the private sector leverage the data to its greatest potential. This helps data innovators and entrepreneurs leverage the information in new and creative ways.  CMS is especially focused on improving the non-identifiable data that it makes available, ensuring that individuals of all skill sets can use CMS’s data resources.

In the past several months, CMS has released:

  • Three years of linked “synthetic” Medicare data that allows data entrepreneurs to develop solutions on a dataset that looks exactly like Medicare data, while protecting beneficiary privacy.
  • Datasets that include average hospital charges, along with average Medicare claims payments, for the 100 most common inpatient services and 30 selected outpatient services.  This data show consumers what hospitals are charging for clinically similar care.
  • Five years (2007-2011) of data on Medicare geographic variation at the county level.  This release supplements existing data at the state and hospital referral region (HRR) level and will enable everyone from health policy researchers, to data entrepreneurs, to consumers to better understand drivers of health care utilization, spending, and quality in their communities and across the country.
  • A visually appealing dashboard using the publicly available geographic variation data to compare Medicare utilization and spending at the state level.  The dashboard allows people with a broad range of data skills to access and understand their states’ Medicare performance relative to the national average and other states.

Making data easier to find

We also are working to better connect users with CMS data.  We recognize that publicly available CMS data are stored in many locations on the CMS website; so, in an effort to make searching for the data easier, we launched the Data Navigator last fall.  The Data Navigator uses an easy point-and-click mechanism to allow users to search for data and information products for specific CMS programs, such as Medicare and Medicaid, or on specific health care topics or care settings.

CMS’s work is just beginning – in the next year we hope to continue our data and analytics work, particularly to make our data dissemination policies more user-friendly and flexible.  However, beneficiary privacy continues to be CMS’ primary priority.  As stewards of the data, CMS has a responsibility to carefully protect this information.

That said, CMS believes that all members of the healthcare system need timely and accurate data in order to transform health care in the United States.  We are excited to continue this work, and look forward to working with you to develop innovative solutions that improve care for all Americans.

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Submitted by Laura on
As a drafter of these programs and their Meaningful Use, I am appalled at the complete failure of this program in patient use, on my own person MyMedicare account. When we were initially working to assure Preventive Care measure were made affordable and available, records would display which services were to be covered by the ACA and dates of eligible use. Now in Aug 2014, none of those services are included, and in fact none of the services I had already used have been removed from the list. It is more like a shopping list than a person and specific patient record, and available services. Also, it appears that now providers must 'accept the Medicare patient assignment', meaning that physicians can decimate against Medicare patients, in order to charge a different, and generally higher fee for services. Then the patient is required to sign a document that state that Medicare may not pay for the services so that the patient must do so at full price. So at my physical, I was offered the bare minimum of height, weight, blood pressure and then after meeting with the physician told that they could draw a CBC only. CBC is a complete blood panel. Then I was required to sign that I would pay for the test if Medicare chose not to cover based on screening or testing verbiage. This is a throw back into the day when patients could not get care due to affordability. Where did we drop the ball. If I could not pay the amount they physician's office decided to charge it would be reflected on my credit report and then if not paid turn over to a credit collection agency. I am extremely disappointed at the failure to create a Meaningful Use System, rather than a data system. Does anyone respond to there comments with suggestion of a resolution?
Submitted by simplemist on
I really like the idea for an 'Open Data' initiative for researchers. Obfuscation and transparency helps provide researchers with clean data, so it becomes less about searching, seeking, et al. More about actually finding quantitative patterns leading to qualitative results. I really like the direction this is headed.