CMS drops cost of claims data in final rule
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-