LANSING – State Representative Scott Dianda (D-Calumet) recently introduced House Resolution 314 encouraging the United States Congress to pass a law that would expand Medicare claims data availability and improve medical care.

“Most of us don’t actually know how much our health care costs because not all insurance companies send us a copy of the bill listing the charges,” said Dianda. “Since we can’t compare costs we don’t know if we’re getting the best price or even the best care. Medicare is one of the biggest payers of health care costs, so if claims data are available, we would have a better view of the health care marketplace and could make educated decisions on costs and quality.”

At present, this Medicare claims information is inaccessible. Federal law allows certain health care reporting entities, known as “Qualified Entities” (QEs), to prepare reports on health care performance measures using Medicare claims data. These QEs can freely disseminate their reports, but they are restricted from selling or otherwise providing the claims data to others. Legislation in Congress – the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 – would remove this restriction and allow QEs to provide or sell Medicare claims data to health care providers, health insurance companies and others to assist them in quality improvement activities.

“Having this claims data is an important first step toward increasing health care price transparency, improving quality and lowering costs,” said Dianda. “My resolution encourages Congress to pass this legislation immediately.”

HR 314 was referred to the House Committee on Health Policy.


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