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Lawmakers Call for Access to Medicare Claims Data

Margaret Dick Tocknell, for HealthLeaders Media, June 20, 2013

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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2 comments on "Lawmakers Call for Access to Medicare Claims Data"


stefani daniels (6/21/2013 at 11:52 AM)
the history of over prescribing and excessive ordering is well known. Claim form information can be viewed as a surrogate measure of resource utilization and much better data than the 'pricing' data recently released. In the hospital setting, the volume of tests, consultants, procedures continues to escalate putting hospitals (which largely get paid a fixed rate) and patients at financial risk (depending upon their insurance). Excessive and non-contributory medical interventions are the last large pool of untapped expenses that can be reined in. The more exposure of physician practice behaviors, the better choices the public can make.

Mary Jo Tomlinson (6/20/2013 at 9:37 AM)
it's called a fee schedule, this information has been available for a long, long time. ...maybe we could try to FIX it..instead of finding ways to make this system more cumbersome..probably to late?