Reproduced with permission from Health IT Law & Industry Report, 7 HITR 10 (May 18, 2015). Copyright 2015 by The Bureau of National Affairs, Inc. (800-372-1033) <http://www.bna.com>

SGR Repeal Law to Expand Release Of Public Claims Data, Boost Big Data Efforts                                             

By Alex Ruoff

May 14 —  The effort to repeal and replace Medicare’s SGR formula was a win for big data analysts and quality improvement groups, industry observers told Bloomberg BNA May 14.

The law, which repeals and replaces the sustainable growth rate (SGR) formula used to calculate Medicare reimbursements to physicians, included a little-discussed provision that will expand the availability of claims data to certain analytics and care-improvement groups.

Expanding the amount of data available to these groups could eventually translate to more effective health-care practices, representatives of claims data analysis groups told Bloomberg BNA.

Joel White, executive director of the Health IT Coalition, a health information technology advocacy group, told Bloomberg BNA that the law will allow the Department of Health and Human Services in 2016 to release new kinds of Medicare data as well as Medicaid and Children’s Health Insurance Program (CHIP) claims data to qualified entities, defined as data analysis organizations approved by the HHS to study raw claims data. The move would double the amount of claims data available to these organizations, White said.

“We think this is key to the bill because it will help change the business model for using this data and for big data,” White said. “Providers are now being evaluated based on this quality data and they’re going to need benchmarking data to make their improvements. So, this creates the business case for providers to have relationships with the qualified entities that have this data.”

Starting July 1, 2016, the law allows the HHS to release new kinds of claims data held by the Centers for Medicare & Medicaid Services and will allow qualified entities to combine certain data sets they’ve previously received from the agency, according to the bill.

White said this means the HHS can release a trove of Medicaid and CHIP claims data.

The CMS is limited in what claims data it can release to the public and to qualified entities. A section of the Affordable Care Act created the program for qualified entities, which are organizations approved by the CMS to receive raw claims data for analysis.

Brammer Quote box

New Data

Qualified entities use billing data to advise health-care organizations on how to best serve their patient populations, Craig Brammer, chief executive officer of the Health Collaborative of Cincinnati, told Bloomberg BNA May 14. These organizations comb through the data to find patterns and possible ways to prevent health issues in a community.

“The secondary use of billing data in general has proven to be hugely impactful at measuring and improving health care in America,” Brammer said. “Historically that’s been largely driven by the private sector, but this bill enables organizations like ours to take those private sector resources [care quality data] with Medicare for a more comprehensive view of how regions like Greater Cincinnati can improve.”

Opening up Medicaid and CHIP data will give qualified entities insights into the health of seniors in those programs, Brammer said.

The law will also allow qualified entities to use the Medicare data they already have in new ways, Brammer said. He said qualified entities will be allowed to combine certain Medicare data sets, allowing them to dig deeper into the data.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at kcasey@bna.com