Employer Access to Medicare Claims Data Expanded in House-Passed "Doc Fix"

Transparency, Quality and Cost Containment

This week, the House overwhelmingly passed an HR Policy-supported bill to repeal Medicare's troubled physician payment formula and improve the program's health care transparency initiatives by expanding employer access to Medicare claims data.  Specifically, the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2), approved by a vote of 392 to 27, would allow organizations that are qualified under the ACA to receive Medicare claims data to analyze and redistribute it to employers for the purpose of providing health care benefits to employees and retirees.  The Qualified Entity (QE) program was created by the ACA to allow organizations to access and analyze Medicare claims data for purposes of evaluating the quality, efficiency, and effectiveness of providers.  However, in its current form, the QE program restricts what organizations are allowed to do with the data.  H.R. 2 would relax some of those restrictions.  The bill also requires HHS to make utilization and payment data for physicians and professionals under Medicare publicly available.  The legislation now moves to the Senate where it is likely to pass, and the President has indicated he will sign it into law.