Christopher Powers, Acting Director
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1 Transparency of Hospital Inpatient and Outpatient Pricing Data The National Summit on Health Care Price, Cost and Quality Transparency Christopher Powers, Acting Director Information Products Group, Office of Information Products and Data Analytics, Centers for Medicare and Medicaid Services December 3, 2013
2 Introduction CMS is the largest single payer for health care services in the US 2.5 billion claims submitted annually Significant additional data sources on the way EHRs Medicare Advantage encounter data Health Insurance Exchange/Medicaid expansion data Receive billions of other non-claim data points Transitioning from a passive payer to active purchaser and expected to drive innovation Trusted to protect beneficiary privacy 2
3 CMS is routinely and safely sharing data to support the transformation of the delivery system Public Use Files Hospital Charge Data Qualified Entities (QEs) Medicare Data Sharing for Performance Measurement Program Researchers Accountable Care Organizations (ACOs) Quality Improvement Organizations (QIOs) States Data Dissemination Activity CMS demonstrations Innovation Center grantees (e.g., Health Care Innovation Awardees) CMS has also allowed beneficiaries full and open access to their Medicare claims data through the Blue Button Initiative 3
4 CMS Information Products CMS is making more program data available in multiple formats to spur innovation and let the private sector leverage the data to its greatest potential CMS Data Navigator ( makes it easy to find CMS data and information products on our website Recently released information products include: Average hospital charges and average Medicare claims payments for the: 100 most common inpatient services 30 selected outpatient services State, HRR, and county level public use files Geographic variation Chronic conditions 4
5 Provider Data Walk-Through
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10 Methods
11 Documentation
12 Data
13 Excel Filtering 2,750 Of these hospitals 602,750 hospitals hospitals, that in performed New 60 Jersey, were major in 30 the had joint state replacement least of New 100 Jersey. discharges without in fiscal complications year or comorbidities are included in the file.
14 Average Covered Charges and Average Payments DRG 470 in NJ: Hospitals with 100 or more discharges Each pair of bars represents an individual hospital.
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17 Data Usage Statistics: Downloads by State as of 5/13/2013, 4 PM Bubble Size represents the number of downloads. In the US, this figure ranged from 221 in Wyoming to 11,972 in California.
18 Data Usage Statistics: Sample of countries that have downloaded data as of 5/13/2013, 4 PM The charge data has been downloaded by individuals in over 50 countries.
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20 Methods
21 Documentation
22 Data
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24 Provider of Service (POS) File Contains an individual record for each Medicare-approved provider and is updated quarterly. Include provider number, name, and address and characterize the participating institutional providers. The data consists of two large files, one for labs and one for 18 other provider types. Previously only available for purchase, now available as a free downloadable file. Available at: 24
25 Other Data Transparency Initiatives
26 Data Navigator CMS DATA Simple, Point-and-Click Interface Search by Program, Setting, Topic, or Geography Valuable to All Users - Novice to Expert CMS WEBSITES EXTERNAL WEBSITES 26
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29 Changing the Performance Measurement Landscape Section authorizes the release of Medicare Parts A, B, and D claims data to qualified entities for performance evaluation of providers Qualified entities must combine the Medicare claims data with other claims data Qualified entities must report measure results publicly after allowing time for providers to review the results and request correction of errors Standard measures: NQF measures or those used in a CMS program Alternative measures: approved through stakeholder consultation or 29
30 Medicare Data Sharing for Performance Measurement NOW FUTURE INSURANCE COMPANIES MEDICARE? INSURANCE COMPANIES MEDICARE? Qualified Entity COMPREHENSIVE CONSISTENT FAIR ACTIONABLE 30
31 Research Data Dissemination The Chronic Condition Warehouse (CCW) is CMS research data warehouse designed to support external researchers and internal CMS research and analytic functions Unique beneficiary ID allows user to link data across all CCW data including: Medicare beneficiary demographics and enrollment ( ) Medicare fee-for-service (FFS) claims ( ) Medicare Part D event data ( ) Medicaid eligibility and claims ( ) Medicare-Medicaid linked files ( ) Assessment data (instrument inception-2012) New data access method: Virtual Research Data Center (VRDC) 31
32 Virtual Research Data Center (VRDC) ACCESS Increases data access > VPN and Virtual Desktop Utilize personal laptops Controlled virtual access can mean greater flexibility in data policy COST Increases efficiency of data delivery Reduces infrastructure costs for data users SECURITY Increases data security > no shipping of external media Satisfies all privacy and security requirements DATA & ANALYSIS Secure File Transfer System (SFTS) transfers data files efficiently and securely Convenient, quicker, and efficient access to CCW data Perform analyses and data manipulation Technical/Analytic support from CCW staff Statistical data output review 32
33 Monthly Data Feeds for ACOs CMS is sending near real-time data to Accountable Care Organizations (ACOs) for patients enrolled in ACO Include beneficiaries entire claims history, including all service types, procedures and supplies. Opportunity for private sector to help ACOs transform the data to clinical information 33
34 VA, DoD and CMS effort to give patients access to their own data (FEHB plans beginning to also offer blue button) 300,000 CMS beneficiaries have downloaded their data to date 2012 enhancements: Moved from 1 year of data to 3 years of data Moved from Parts A and B data to Parts A, B and D data Opportunities for private sector Blue Button 34
35 Geographic Variation Dashboard 35
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38 Chronic Condition Dashboard 38
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40 Questions?
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