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Lawmakers Call for Access to Medicare Claims Data

 |  By Margaret@example.com  
   June 20, 2013

A Senate bill would make Medicare claims and payment data available to the public in a searchable database that would be free to use.

On the heels of a Senate Finance Committee hearing that explored a wide range of healthcare pricing and transparency issues, three committee members introduced on Tuesday a bill to make Medicare claims data available to the public.

The Medicare Data Access for Transparency and Accountability Act (Medicare DATA Act) would require the Department of Health and Human Services to issue regulations making Medicare claims and payment data available to the public in a searchable database that would be free to use.

The bill requires that each provider be identified by a "unique identifier that is available to the public...such as the National Provider Identifier." It also clarifies that Medicare payments to physicians and suppliers do not fall under a Freedom of Information exemption.

In introducing the bill in the Senate, Sen. Chuck Grassley (R-IA) noted that with only a few exceptions almost all federal spending is available on the Internet through www.openspending.com. "That means virtually every other government program... is more transparent than the Medicare program."

He also sees the effort as countering waste and fraud in the $549 billion Medicare program. "If doctors know that each claim they make will be publicly available, it might deter some wasteful practices and overbilling."

In his comments to the Senate, Sen. Ron Wyden (D-OR), a bill co-sponsor, said the database will help patients in making medical decisions and help taxpayers understand what their tax dollars pay for in the Medicare program. "Why isn't this information already available?" he asked.

The third co-sponsor is Sen. Michael Bennet (D-CO).

This is the second effort to gain legislative support for the release of Medicare billing and spending data. Sen. Grassley's first effort in 2011 languished in committee, but the emphasis on price transparency and the demand for meaningful data may help it win sufficient support this time around.  

Over the past several weeks the Centers for Medicare & Medicaid Services has broken with precedent and released volumes of pricing data. In May it provided the chargemaster data for the 100 most common Medicare inpatient diagnostic related groups or DRGs. Last week at Datapalooza IV, the fourth annual national conference on health data transparency, CMS released several data bases, including estimates for average charges for 30 types of hospital outpatient procedures.

Researchers, data aggregators, and lawmakers, are clearly eager for more.  

At Tuesday's Senate Finance Committee meeting, there was a general acknowledgement that CMS has control of a treasure trove of healthcare pricing and quality information. "All data on price, utilization, and quality of healthcare should be made available to the public unless there is a compelling reason not to do so," stated Giovanni Colella, MD, CEO of Castlight Health, which provides healthcare cost and quality information to employers. Colella was one of four witnesses asked to speak at the hearing.

"What's the responsible argument, if there is one, why CMS should not release all this data?" asked Sen. Max Baucus (D-MT), chair of the Senate Finance Committee. "I have never heard one."

"There is no compelling argument," responded Sen. Wyden. "This is a treasure trove of valuable information that needs to be released in a way that's sensitive to protecting personal issues. Once we get this information it will give us lots of clarity with respect to practice patterns across the country. For the first time we'll actually know what Medicare reimburses for specific services."

Historically, some large and influential provider groups have objected to the release of certain data. Until recently, a decades-old court injunction supported the American Medical Association's stand that the release of individual physician records is a privacy violation. In May a federal judge vacated the injunction at the behest of several news organizations. The AMA is reportedly considering its options.

Efforts to reach the AMA to comment on the Medicare DATA Act were unsuccessful.

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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