Releasing Medicare Claims Data to Support Quality Improvement Initiatives

Legal Barriers and Opportunties

Community groups such as those in the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative have been using private medical claims data to measure and publically report on the performance of doctors. But another vast pool of information about how health care is being delivered in America has been largely off limits—Medicare claims data. Combined with private data, it could facilitate considerably more accurate measurement of performance and better public reports to empower consumers and spur improvements in quality. So what are the legal barriers and opportunities for that to happen?

A new brief from the George Washington University School of Public Health & Health Services examines federal law and pending health reform legislation to find the answers. Authors Jane Hyatt Thorpe, Erica Pereira and Sara Rosenbaum conclude that the Centers for Medicare and Medicaid Services (CMS) has discretion—and may soon have more—to release Medicare data for research projects and demonstrations with community organizations that meet agency standards and can demonstrate adequate capabilities to ensure data security and safeguard patients’ privacy.

The authors summarize current CMS initiatives aimed at promoting broader release of performance data and outline how, regardless of what happens with health reform legislation, the administration can use existing CMS authority to expand access to Medicare data for community-based research or demonstration projects.