The Journal of the American Medical Association (JAMA), recently published a Viewpoint article entitled “Time to Release Medicare Advantage Claims Data” by Niall Brennan, Charles Ornstein, and Austin B. Frakt (February 19, 2018). After pointing out that almost 33% of the Medicare population is enrolled in Medicare Advantage (MA) plans at a cost of over $200 billion a year, the authors note that “[d]espite the important and increasing role of Medicare Advantage plans, there is fairly little insight into the relative value Medicare Advantage provides to beneficiaries or the funder, the US taxpayer. This is attributable mainly to a lack of access to comprehensive claims- or encounter-level data regarding the Medicare Advantage program for researchers, or even more aggregated information that could be made available to the general public.”
The article explains that the Centers for Medicare & Medicaid Services (CMS) was on track to release more encounter data but “abruptly cancelled” this release in mid-2017. The authors state this “abrupt shift is troubling for a number of reasons” including:
“First, taxpayers deserve to know how their money is being spent […] The taxpayer cost of a Medicare Advantage enrollee exceeds that of a comparable traditional Medicare enrollee […] Multiple audits have found that Medicare Advantage plans have overcharged the government by overstating the severity of the diagnoses of patients…”
“Second […] there have been many claims made over the years regarding the merits of Medicare Advantage in contrast to traditional Medicare. Some studies show that Medicare Advantage has higher quality in certain dimensions, such as higher rates of preventive care and screenings among recipients. Others suggest that Medicare Advantage does not serve certain beneficiaries well, such as those with greater illness severity. But findings such as these have been based on aggregate or incomplete data. The quality of Medicare Advantage relative to traditional Medicare cannot be thoroughly adjudicated with existing Medicare Advantage data because such data are not comprehensive with respect to all the care enrollees receive or as granular as traditional Medicare data.” [citations omitted]
“Third, there is a compelling argument to release these data to continue the recent advances made in transparency and open government.”
The article concludes: “For the past few years, those not directly involved in running Medicare Advantage have been squinting through keyholes to make some sense of what it provides. The time to bring the program into the full light of day is long overdue.”
The Center for Medicare Advocacy concurs.