CMS Data Transparency Activities. Niall Brennan, Acting Director Office of Enterprise Management
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1 CMS Data Transparency Activities Niall Brennan, Acting Director Office of Enterprise Management
2 The Early Morning Angst of the MLGF 2
3 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 Marketplace/Medicaid expansion data Receive billions of other non-claim data points CMS (and other payer) data seen as critical enabler and driver of health system transformation Trusted to protect beneficiary privacy 3
4 CMS must balance multiple competing interests and sensitivities regarding data release practices to protect beneficiary privacy Legal authorities serve 2 functions: Rules of the Road 1. Authorize or allow CMS to release data to a specific entity for a specific purpose 2. Place restrictions on the type of data that can be disclosed and to whom (Privacy Act of 1974 & HIPAA) All external data users are expected to sign a Data Use Agreement (DUA) which establishes approved uses of the data and informs the user of penalties associated with misuse of the CMS data CMS also conducts a data security review before disclosing data (waived for covered entities and other federal agencies) 4
5 As stewards of the data, CMS has a responsibility to carefully protect beneficiaries sensitive personal and health information Must ensure that public use files (PUFs) are complaint with: HIPAA s de-identification rules (since CMS is a covered entity under HIPAA) Two methods of de-identification are allowed under HIPAA: Safe harbor Expert determination Did I Mention Privacy!!!! CMS privacy policy No cell (e.g. admittances, discharges, patients, services) 10 or less may be displayed. Also, no use of percentages or other mathematical formulas may be used if they result in the display of a cell 10 or less 5
6 Why Transparency? 6
7 Walking the Data Transparency Walk (not just talking the talk!) 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: One-stop shop for finding CMS data on our website Simple point-and-click interface Nearly 300 active data sources Hospital Charge Data Physician Data Geographic Variation Data Chronic Condition Data Open Payments Data And more.. Available at: 7
8 Recent High Profile CMS Data Releases Three datasets that summarize utilization, payments, and charges for procedures and services provided to Medicare fee-for service beneficiaries Dataset Key Variable(s) Years # of Providers # of Records # of Views Hospital Inpatient Stays DRG FY2011 & FY2012 3,000+ Hospitals Over 155, ,000 (since May 2013) Hospital Outpatient Visits APC CY2011 & CY2012 3,000+ Hospitals Over 40,000 99,000 (since June 2013) Services Delivered by Physicians and Other Suppliers HCPCS, Place of Service CY ,000+ Individual Providers Over 9M 400,000 (since March 2014) 8
9 A Miracle of Competence in Government 9
10 You ve GOT to Start Somewhere Regardless of What Conventional Wisdom Says Brendan Behan ( ) Critics are like eunuchs in a harem 10
11 Average Hospital Inpatient Charges for MS-DRG 470 (FY2011) National average = $50,116 11
12 Change in Average Hospital Inpatient Charges for MS-DRG 470 from FY11 to FY12 National average = $2,116 12
13 Physician Utilization Data Don t just dump raw data on the web! Search for a provider by name, address, or National Provider Identifier (NPI) Tool returns information about the services the provider furnished to Medicare beneficiaries 13
14 Open Payments New data product that shows financial relationships between the health care industry, and physicians and teaching hospitals Data set (released Sept 30 th, 2014) contains 4.4 million payments valued at nearly $3.5 billion attributable to 546,000 individual physicians and almost 1,360 teaching hospitals 14
15 State, County, and HRR Data Products Public Use Files (PUFs) and interactive dashboards with aggregated indicators at the state, HRR and county level on: Chronic conditions Geographic variation in spending and quality Based Medicare claims data for beneficiaries enrolled in FFS 15
16 CMS is routinely and safely sharing data to support the transformation of the delivery system Accountable Care Organizations (ACOs) Qualified Entities (QEs) Medicare Data Sharing for Performance Measurement Program Researchers Data Dissemination Activity States (both care coordination and research) Quality Improvement Organizations (QIOs) 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 16
17 Virtual Access to CMS Data (aka The Future ) 17
18 State Agency Research Requests Streamlined research request process tailored specifically to state s requests States may request Medicare data, updated as frequently as quarterly, for all beneficiaries in their state If a state agency chooses to "opt-in" to data sharing, the agency may: Reuse the data for additional research (beyond the research activities specified in their initial data request) Further disseminate the data to other state agencies who are conducting research or to other entities conducting research that is directed and funded by the state Requests are still submitted through ResDAC ( 18
19 INEVITABLE (its already here) WAY HARDER THAN MOST PEOPLE REALIZE Both Internal and External Barriers Cultural Resistance What if the data is wrong? Legal Restrictions VERY MUCH A WORK IN PROGRESS How do we measure impact? How do we know what works? Who is the audience? Transparency is 19
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