CMS has long been the repository of detailed and pertinent information on Medicare claims, treatments and payments. They have been extremely restrictive in allowing access to that information, particular as it relates to specific providers. The health care reform act, however, included a provision which allowed them to loosen those restrictions and make the information publicly available.
The public access, however, does not extend to the end consumer but remains restricted to specific organizations. These groups will be comprised of doctors, health insurers, businesses, consumers and government that are working as a community group at the local level to improve health care. It is estimated that there will be about 25 such groups nationwide who will be able to mine the data and use it to publish studies. The information will not reveal patient specific information but it will disclose physician specific information.
The AMA supports the disclosure of the information when it improves patient care but is a concern since it could reflect inaccurate or misleading findings. There is also discussion about whether and how the data could be used in legal proceedings, and is under review in some current litigation stemming from a recent Wall Street Journal article alleging fraud and abuse based upon their review of the Medicare data.
The specificity of the data to be publicly released by these groups and the potential use of the information from pharma on physician behavior and prescribing remains uncertain as well.