Fall­ing prices

CMS drops cost of claims data in fi­nal rule

Modern Healthcare - - THE WEEK IN HEALTHCARE - Mau­reen Mck­in­ney

Depart­ment stores aren’t the only ones slash­ing prices for the hol­i­days. The CMS seemed to be lis­ten­ing to con­cerns from the field about high costs when it un­veiled the fi­nal ver­sion of a rule that makes its Medi­care claims data ac­ces­si­ble to se­lected re­gional qual­ity or­ga­ni­za­tions.

Such groups had long lamented the lack of avail­able data on the qual­ity and cost of care for older Amer­i­cans, but the pro­jected price tag in­cluded in the pro­posed rule—roughly $200,000 for three years of data on 2.5 mil­lion Medi­care ben­e­fi­cia­ries— was far too high for the lean, not-for-profit or­ga­ni­za­tions most in­ter­ested in the in­for­ma­tion, they said.

In the fi­nal rule, re­leased Dec. 5, the CMS low­ered the pro­jected fee by 80%, to about $40,000 for three years of data.

“We are very pleased,” said David Hop- kins, a se­nior ad­viser with the Pa­cific Busi­ness Group on Health, a San Fran­cis­cobased busi­ness coali­tion. “Con­sumers need bet­ter in­for­ma­tion about the qual­ity of care pro­vided by physi­cians, and you need a lot of pa­tient data to re­li­ably mea­sure per­for­mance. That’s what this gives us.”

Man­dated by the health­care re­form law, the rule re­quires the CMS to pro­vide ex­tracts of ad­min­is­tra­tive claims data to qual­i­fied en­ti­ties for use in gaug­ing provider per­for­mance in their re­gions. The agency says it ex­pects about 35 ap­pli­cants for ap­prox­i­mately 25 spots open for el­i­gi­ble or­ga­ni­za­tions. The rule will take ef­fect in Jan­uary, and the CMS will ac­cept ap­pli­ca­tions on a rolling ba­sis with no dead­line.

The CMS came up with the orig­i­nal $200,000 price listed in the pro­posed rule, an­nounced June 3, by cal­cu­lat­ing the cost of pro­cess­ing ap­pli­ca­tions, cre­at­ing cus­tom­ized data sets, mon­i­tor­ing qual­i­fied en­ti­ties and en­sur­ing se­cure data trans­mis­sion. But they backed off from that to­tal af­ter many re­gional qual­ity groups said the cost would likely pre­vent them from par­tic­i­pat­ing.

The groups also ar­gued that the qual­ity re­ports and tools that they would pro­duce with Medi­care’s data would serve a pub­lic good.

In re­sponse, the CMS omit­ted the pro­gram man­age­ment fees from the to­tal cost, bring­ing the fee for each en­tity down to about $40,000.

“CMS con­curs that there are pub­lic in­ter­ests at stake that jus­tify nar­row­ing the scope of what con­sti­tutes the cost of mak­ing this data avail­able,” the agency said in the fi­nal rule.

In a news re­lease, CMS Act­ing Ad­mi­nis-

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