Dive Brief:

• Physicians will be able to access historical Medicare claims data for patients under a new pilot announced by CMS on Tuesday called "Data at the Point of Care."

• The agency will deploy test data to a limited number of providers that request access in August, and will start issuing production data in September and October. Once implemented, a physician would have access to Medicare claims data for patients, such as other healthcare providers seen, medications prescribed, procedures and diagnoses.

• CMS predicted wide participation among providers based on surveys. If the pilot is successful, the agency will roll out the API to all Medicare fee-for-service providers.

Dive Insight:

The effort is the latest attempt to marshal the mounds of patient data being gathered for better decision making and care.

CMS Administrator Seema Verma, speaking at the White House Blue Button Developers Conference, noted that agency first rolled out the program for accountable care organizations, and now is moving to physicians. The pilot uses an API under the Fast Healthcare Interoperability Resource Bulk Specification.

The record of Medicare claims data will provide doctors with a better picture of a patient’s medical history, according to Shannon Sartin, executive director of the US Digital Service, a tech arm of the government. For example, if a doctor is seeing a new patient, they would be able to see if the patient recently went to urgent care or underwent surgery.

"For existing patients it will let you know whether they actually went and did the things you ordered for them," Sartin told Healthcare Dive. "So if you refer them to a cardiologist, did they actually go get the visit with the cardiologist. If you prescribed a medication, did they actually fill the medication."

The pilot program will be opt-out for patients, not opt-in, according to CMS. Verma told reporters the agency is aware increased access to data comes with increased challenges to protect privacy, noting CMS is working to validate doctors in the program have a relationship with a patient before data is handed over.

"From providers to ACOs — and in every aspect of our healthcare system — our move to value requires access to the data that helps better deliver patient care," Verma said.

Verma told Healthcare Dive CMS is not proposing regulations to force private payers to provide historical claims data to doctors akin to the Medicare pilot, but noted many large payers are already experimenting with similar ideas.

In February, CMS issued its Interoperability and Patient Access Proposed Rule, which would require health plans to share patient claims data through an API. 

"We look forward to issuing a final rule very soon," Verma said at the White House Tuesday.

More than 1,100 organizations are now using synthetic data in the Blue Button 2.0 sandbox, with 28 production applications using real data, according to CMS.