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Medicare increases consumer access to provider data

Consumers and employers will have the healthcare information they need to make more informed choices about their care under a provision of the Affordable Care Act, the Centers for Medicare & Medicaid Services announced in a final rule Monday.

The rule gives qualified organizations, such as employers and consumer groups, access to data that can help them identify high quality healthcare providers or create online tools to help consumers make educated healthcare choices. Information that could identify specific patients, however, will not be publicly released and strong penalties will be in place for any misuse of data.

“This is a giant step forward in making our healthcare system more transparent and promoting increased competition, accountability, quality and lower costs,” Marilyn Tavenner, RN, BSN, MHA, acting CMS administrator, said in a news release. “This provision of the healthcare law will ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar.”

For years, according to CMS, employers, consumers and healthcare quality advocates have expressed frustration about the limited and piecemeal availability of Medicare data that could be used to help evaluate healthcare provider or supplier performance. Although many health plans have created provider and supplier performance reports, these reports are based solely on the health plans’ own claims, and do not reflect information from other health plans, including Medicare.

Providers, too, have expressed frustration at receiving performance reports that are piecemeal and produced without an opportunity for review and correction. This final rule creates a framework for providers to receive a single, actionable performance report covering all or most of their practice.

The final rule makes a number of important changes from the original proposed rule. The final rule makes this data less costly for qualified entities, gives qualified organizations more flexibility in their use of Medicare data to create performance reports for consumers, and extends the time period for healthcare providers to confidentially review and appeal performance reports before they become public.

The rule also includes strict privacy and security requirements to protect patients and healthcare providers and suppliers, as well as stringent penalties for any misuse of Medicare data.

For more information on the final rule, visit and to download a PDF of the rule, visit

By | 2011-12-11T00:00:00-05:00 December 11th, 2011|Categories: Nursing careers and jobs, Specialty|0 Comments

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