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Life Health > Health Insurance > Your Practice

Consumers Union: You Call THIS Transparency?

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A group that helps Americans shop for computers and toasters is asking why federal regulators want to charge $200,000 for the data it would need to develop health care provider performance reports.

Steven Findlay and Lisa McGiffert, health ratings specialists at Consumers Union, Yonkers, N.Y., discuss the proposed charges for Medicare billing data in a letter commenting on a Medicare data-sharing proposed released by the Centers for Medicare & Medicaid Services (CMS), an arm of the U.S. Department of Health and Human Services, in June.

Section 10332 of the Patient Protection and Affordable Care Act of 2010 (PPACA) calls for CMS to share Medicare provider billing data that could help outside organizations develop provider quality measures, and for users of the data to cover the cost of the data-sharing program.

CMS has suggested that the “qualified entities” that get the program ought to be able to show that they have at least 3 years of experience with working with Medicare data sets or other large data sets; that they give CMS a detailed plan showing what they intend to do with the data; use standard, pre-approved quality measures, or submit any alternative measures to be used to a CMS review process; and make users share the cost of developing and running the entire data-sharing program, as well as the extra costs CMS incurs when it screens data-use applicants and actually providers the data.

Qualified entities also would have to give providers a chance to review and correct the data.

Randal Johnson and Kate Mahoney, representatives from the U.S. Chamber of Commerce, Washington, and note in a chamber comment letter that CMS has estimated providing data on 2.5 million beneficiaries would be about $200,000.

The proposed rules “seeem to be at odds with HHS’ overall effort to ‘free’ health care data,” Findlay and McGiffert say. “The proposed rules impose too many obstacles in the path of potential qualified entities and too many bureaucratic requirements on approved qualified entities. The costs alone are excessive in our view and represent a significant barrier that will inhibit many applicants, and thus inhibit experimentation and fresh ideas in this emerging area.”

Moreover, the provider review requirement is unrealistic, because, today, there is “no accurate or acceptable physician contact data base or directory” available, on a nationwide, statewide or, in most communities, local basis, Findlay and McGiffert say.

ProPublica, New York, a nonprofit organization that describes itself as being a public interest journalism organization, is making an article about the proposal comments available free of charge to other media organizations.

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