CMS finalizes rules allowing sale of claims data to providers, employers

Medicare and private sector claims data will be permitted to be sold or shared to organizations which will use the information to improve care, as long as those recipients followed privacy and security requirements laid out in newly finalized CMS rules.

First proposed in January, the rule changes the Qualified Entry Program. Organizations vetted and approved by CMS can use this claims data to provide or sell analyses of the data to providers, employers and other groups with the goal of improved patient care. Qualified organizations can also sell the combined data, or provide the Medicare claims data at no cost, to providers, hospital groups, suppliers, or medical societies.

“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,” CMS Chief Data Officer Niall Brennan said in a statement.

Much of the 111-page rule deals with how the claims data will be protected. Qualified entities which provide or sell non-public analyses will have to file an annual report, which will include specifics on the number of analyses, how many and what kinds of organizations bought those analyses, and how much the qualified entity was paid.

Throughout the entire process, existing privacy laws will have to be followed, including HIPAA protections.

“We believe these changes to the qualified entity program will be important in driving higher quality,lower cost care in Medicare and the health system in general,” the rule states. “We also believe that these changes will increase interest in the qualified entity program, leading to more transparency regarding provider and supplier performance and innovative uses of data that will result in improvements to the healthcare delivery system while still ensuring appropriate privacy and security protections for beneficiary-identifiable data.”

As of March 18, 15 qualified entities can participate in the data-sharing program, though CMS expects more to seek approval after the release of this rule. Only four of those 15 organizations (Health Care Cost Institute, Amino, OptumLabs and FAIRHealth) are listed as reporting on provider performance nationwide.