• More Data, But Not Enough

    From Kaiser Health News today:

    A new Centers for Medicare and Medicaid Services Web site is making more claims data available to the public, Modern Healthcare reports. … Medicare Advantage patients are not included in the data set …

    CMS will also release data sets that include all Medicare claims for a five percent sample of beneficiaries later this year, CQ Health Beat reports. “Researchers have long urged Medicare to give them wider access to such data so they can unearth ways to improve the efficiency of health care.” The releases are part of the Obama administration’s “Open Government Directive” (Reichard, 4/7).

    Beneficiary-level Medicare claims data to be released publicly!?!? Wow! Of course they will be thoroughly stripped of all identifiers including, I am sure, geographic identifiers below the state or region level. That’s necessary for public release but renders the data not terribly useful for most research. (Researchers can obtain identifiable Medicare claims data with approval and after institutional review board scrutiny.)

    Recognize what’s missing: Medicare Advantage (MA) data. And what is so different about MA than the rest of fee for service (FFS) Medicare? It’s provided by private companies. They’ve been able to keep claims data close to their vests for years, to the detriment of research. Consequently, we don’t know as well as we could or should the extent to which MA plans are overpaid for the risk of patients they serve.

    Today we’ve seen two “MA” data access problems: Medicare Advantage and Massachusetts. The common denominator is private, not public, provision of insurance. There’s no good reason why the public shouldn’t know more about what it’s paying private companies contracting for government services. It’s not a healthy pattern for taxpayers.

    Share
    Comments closed
     
    • I am surprised that more has not been written about MA, given its premise for existence. IIRC, it was supposed to show that profit driven companies would be better at holding down costs. It appears to have failed.

      Steve

      • @steve – You do recall correctly. And before 1997 Medicare HMOs were paid 95% of FFS costs because they were supposed to be 5% more efficient. Whoops! Clearly their mission has morphed.