Making Better Use of Medical Data to Improve Quality, Lower Costs

by Congressman Paul Ryan
 
 
The federal government today sits on a treasure trove of medical data that could be used to improve the quality of health care and help patients and their families make informed decisions about their medical treatment.  Unfortunately, this information about the cost and quality of care that hospitals and doctors deliver across the country is collecting dust in government computer files, rather than being put to optimal use to improve our health care system. 
 
That is why I have introduced the Medicare Quality Enhancement Act with Congressman Artur Davis (D-AL).  Our bipartisan legislation authorizes the secure disclosure of Medicare data to qualified private-sector organizations, known as Medicare Quality Reporting Organizations (MQROs), with whom the government enters into a contract that includes safeguards to protect patient privacy.  These organizations will analyze the data and develop reports on the quality, cost, efficiency and effectiveness of our health care system. 
 
These reports will help inform the public so people can make better decisions about their medical care.  This information will also aid health care providers, policymakers, patient advocacy groups and others with improving the quality and lowering the cost of health care.  In the U.S. Senate, this legislation has been introduced by Senators Judd Gregg (R-NH) and Hillary Clinton (D-NY).  
 
Under our proposal, private-sector groups can submit a request to an MQRO for a report, and MQROs may charge the group making the request a reasonable fee for the development and release of the report.  The report must be made available to the public no later than one year after the date that the report is released to the organization that requested it. 
 
The legislation requires the protection of Medicare beneficiary privacy under both the Health Insurance Portability and Accountability Act (HIPAA) and the Privacy Act, and it requires a privacy review by the U.S. Department of Health and Human Services of each analytical report prior to release.  In addition, MQROs must meet certain qualifications.  For example, an MQRO must have the information technology infrastructure to securely store the Medicare claims database and have the research expertise to develop reports on health care quality and efficiency.      
 
In order for patients and their families to make the best decisions about their medical care, they need reliable information on the cost and quality of care that doctors and hospitals provide.  This bill will help by making better use of the vast amount of health care data the federal government holds through Medicare.  If researchers are able to analyze this information and release their findings to outside groups and the public, this will help pinpoint problems, improve quality, and drive down costs.