Physician Practice

CMS to expand access to data for quality improvement measures

Physician Practice Insider, February 9, 2016

A proposed rule would expand access and use of claims data and analysis, according to CMS. The new rule, which is required by the Medicare Access and CHIP Reauthorization Act of 2015, aims to help providers make better patient care decision and overall quality improvements, CMS says. Under the proposed rule, organizations approved as qualified entities will be allowed to share or sell analyses of Medicare and private sector claims data to providers and other groups, such as employers, who are able to use that data to improve patient care. The rule does have stringent privacy and security requirements for qualified entities as well as entities receiving data, and will also incorporate annual reporting requirements.

Qualified entities will combine protected Medicare data with claims data from other payers, including Medicaid and commercial payers, to create quality reports that show how providers and suppliers perform across payers. These reports would not be for public use.

The proposed rule details:

  • Limitations that would be placed on qualified entities and authorized users
  • Legal agreement requirements
  • Requirements and limitations on data dissemination
  • Definitions of authorized users, employers, health insurance issuer, and other organizations involved in the disclosure, transmittal, or receipt of data
  • Annual reporting requirements for data and analyses
  • Breach assessment procedures
  • The process for reviewing, appealing, and correcting analyses


Thirteen organizations have been approved as qualified entities, CMS says. Two of these qualified entities have completed public reporting.

The proposed rule was published in the Federal Register February 2. CMS is accepting public comments until March 29.

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