Improve Medicare Program's Privacy Protection, APA Says

A newly proposed rule on the release of Medicare claims data for use in measuring physician performance should be bolstered by additional safeguards to ensure patient privacy, according to APA Medical Director James H. Scully Jr., M.D., in a letter submitted to the Centers for Medicare and Medicaid Services (CMS).

Scully's letter serves as a supplement to the AMA's more detailed comments on the proposed rule, which APA cosigned with 80 other physician organizations.

"APA remains very concerned that Medicare beneficiaries' health care data not be compromised," Scully wrote in the August 3 letter. "Psychiatric patients often have a heightened sensitivity to others' use of their patient data. This sensitivity should spur CMS to do its best to enhance existing and future patient privacy and security safeguards, while simultaneously working to improve the quality of medical services provided to Medicare beneficiaries."

In the rule, CMS proposes the implementation of new requirements governing release of Medicare data to "qualified entities" for evaluation of health care providers pursuant to the health care reform law scheduled to take effect in 2012. The agency defines a qualified entity as "a public or private entity that is qualified (as determined by the Secretary) to use claims data to evaluate the performance of providers of services and suppliers on measures of quality, efficiency, effectiveness, and resource use... and meets such other requirements as the Secretary may specify, such as ensuring security of data."

According to CMS, the new reporting program is designed to improve the quality and lower the cost of Medicare, as well as "increase the transparency of provider and supplier performance."

The proposed rule outlines how entities can become eligible to receive Medicare claims data, how the data should be sourced and used, how to protect the rights of both patients and providers, and how entities will be monitored in gathering claims data and producing performance reports.

The AMA's 12-page letter to CMS also called on the agency to ensure that physicians are able to review the accuracy of their data and to appeal the inclusion in the reports of incorrect information prior to its being made public. Additionally, the AMA urged CMS to standardize the process by which qualified entities develop their reports, as well as specify the type of information the reports will contain.

"If done correctly, public reporting has the potential to help provide appropriate and accurate information to patients, physicians, and other stakeholders that can improve quality at the point of care," AMA and its cosigners said. "If not approached thoughtfully, however, public reporting can have unintentional adverse consequences for patients."

APA's letter to CMS is posted at <www.psych.org/MainMenu/AdvocacyGovernmentRelations/GovernmentRelations/RegulatoryComments/Medicare-Data-for-Performance-Measurement.aspx?FT=.pdf>. The AMA's letter is posted at <www.ama-assn.org/resources/doc/washington/medicare-data-release-sign-on-08aug2011.pdf>. The proposed rule is posted at <www.gpo.gov/fdsys/pkg/FR-2011-06-08/pdf/2011-14003.pdf>.