By Marilyn Tavenner, CMS Administrator

As we approach the beginning of Medicare open enrollment on October 15, the Centers for Medicare & Medicaid Services (CMS) wants everyone to know that for most seniors who have Original Medicare, the 2015 Part B premiums will remain unchanged for a second consecutive year. This means more of seniors’ retirement income—and any increase in Social Security benefits—stays in their pockets.

In addition, quality continues to improve both in Medicare Advantage and the Part D Prescription Drug Program, as more people with Medicare get access to higher quality plans. About 60 percent of people who have a Medicare Advantage Plan are currently enrolled in plans with four or more stars for 2015, compared to an estimated 17 percent back in 2009 (Medicare Advantage enrollment is projected to reach an all-time high in 2015, with more than 16 million beneficiaries). Likewise, about 53 percent of Part D enrollees are currently enrolled in stand-alone prescription drug plans with four or more stars for 2015, compared to just 16 percent in 2009.

CMS calculates plan star ratings for Medicare health and drug plans on a scale of 1 to 5—with 5 being the best—based on quality and performance. These ratings are designed to help beneficiaries, their families, and caregivers compare plans. Overall, the number of Medicare Advantage Plans and prescription drug plans earning four or more stars for 2015 increased by 6 and 36 percent, respectively, compared with 2014.

Improved quality in Medicare health and prescription drug plans is just one of the many positive changes we’ve seen since the Affordable Care Act was signed into law.

Thanks to slower than expected growth in health care, premiums and deductibles in 2015 for the approximately 49 million Americans enrolled in Original Medicare will remain unchanged at $104.90 and $147, respectively. For the fourth year in a row, Medicare premium costs are meeting or beating expectations. According to Health & Human Services, premiums will be at least $125 lower over the course of a year then what the Congressional Budget Office (CBO) estimated for 2015 back in 2009.

This news comes as historically slow growth in health care costs continues. Health care prices are rising at their lowest rates in nearly 50 years, Medicare spending per beneficiary is currently falling, and—according to a major annual survey released last month—employer premiums for family coverage grew just 3.0 percent in 2014, tied with 2010 for the lowest percentage increase on record back to 1999.

We’re continuing to work hard to make sure this good news continues. The lower costs and better care is good news for the Trust Funds, great news for taxpayers, and even better news for people with Medicare.

CMS announces first report on provider performance from a Qualified Entity

Niall Brennan, Acting Director, CMS Offices for Enterprise Management

Data can play an integral role in helping consumers decide on everything from which car to drive to choosing a hotel. Indeed, data-driven decision support tools are available in almost every sector. Though many tools are available in health care, the sector as a whole has lagged behind others in providing data on health care quality and cost.

Today, we are excited to announce the first public report on provider performance and cost facilitated by the Medicare Data Sharing for Performance Measurement Program, known as the Qualified Entity Program. The Qualified Entity Program allows organizations that are certified as qualified entities (QEs) to combine Medicare claims data from the Centers for Medicare & Medicaid Services (CMS) with claims data from other payers to evaluate the performance of health care providers and suppliers. QEs must protect the privacy and security of the Medicare claims data and may use it only for purposes of the QE Program. While community-based groups across the United States have been working for two decades to better understand the quality and cost of health care within their communities, many of their efforts have focused on combining claims data from private payers within the community and sometimes from Medicaid programs. For the first time, organizations are able to analyze Medicare claims data alongside claims data from private payers and Medicaid. These new reports from QEs include care provided to the elderly and disabled population (a population with the greatest health care needs).

The first public report using Medicare data comes from the Oregon Health Care Quality Corporation (Q-Corp), an organization that produces data and analytics about the quality and utilization of health care in Oregon. Q-Corp was one of the first entities to be certified for Medicare data sharing. The addition of Medicare data has allowed Q-Corp to offer providers and consumers more complete information about the quality of care across the state of Oregon. The Medicare data has also allowed Q-Corp to publish quality measures for clinics that did not have a large enough patient population for reporting using only commercial and Medicaid data.

Today’s announcement is the latest of several efforts that demonstrate this Administration’s commitment to making health care performance and cost more transparent. As the single largest payer for health care in America, the CMS generates billions of data points each year. For decades, CMS has been an innovator in the use of this data.

Earlier this year, CMS released data on the services and procedures provided to Medicare beneficiaries by hospitals, physicians, and other health care professionals. These data, which do not include any personally identifiable information, summarize the utilization and payments for procedures and services provided to Medicare fee-for service beneficiaries by providers. With this information, consumers have unprecedented access to information about how care is delivered in the Medicare program. In addition, CMS continues to make data available to consumers through the Compare tools. These tools allow consumers to compare nursing homes, hospitals or physicians throughout the country based on the quality measures reported to CMS. People can use this information to inform their selection of a provider and to discuss outcomes and performance levels with their primary care physician before receiving a referral.

Q-Corp is one of 13 QEs currently certified by CMS. We are looking forward to additional public reports from other QEs to help drive health care data transparency, improve quality, and reduce costs in the coming year.

Accelerating states’ efforts on Medicaid delivery system reform

By Cindy Mann, Deputy Administrator and Director, Center for Medicaid & CHIP Services and Patrick Conway, M.D., Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer

As part of its commitment in working with states to improve care and improve health for Medicaid beneficiaries, and through these improvements, reduce costs, the Centers for Medicare & Medicaid Services (CMS) is launching a new collaborative initiative called the Medicaid Innovation Accelerator Program. Over $100 million will be invested over five years to help states accelerate the development and testing of new state-led payment and service delivery innovations to improve health, improve care and decrease costs for individuals enrolled in Medicaid.

Over the past few years, CMS has listened to and consulted with states and stakeholders on health care reform efforts. Based on these discussions and the recommendations from the National Governors Association’s (NGA) Health Care Sustainability Task Force, this initiative will focus on key targeted areas to support state leaders and jumpstart states’ efforts to undertake Medicaid delivery system and payment reform.

All states can be laboratories for health care reform. Fifteen states have initiated comprehensive health homes for people with multiple chronic conditions. Several states have developed shared savings payment models. Thirteen states are testing new delivery and payment models for people who are dually eligible for Medicaid and Medicare. And twenty-five states are currently participating in the CMS Innovation Center’s State Innovation Models initiative. While payment and service delivery innovation is well underway in states, there are gaps and challenges that can be addressed. The Medicaid Innovation Accelerator Program will help strengthen state Medicaid program capabilities in technical areas such as data analytics, service delivery and financial modeling, quality measurement and rapid cycle evaluation to move their Medicaid payment and service delivery models to the next level.  

We are excited to be able to offer this new set of technical assistance resources to state leaders to improve their health care systems and provide better health care for their residents with Medicaid, at lower cost.    

For more information on the Medicaid Innovation Accelerator Program, please visit:

Star Ratings Coming Soon to Compare Sites on

By Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer

When buying a product or service, looking at ratings can often help narrow down the choices. Some websites offer “star” ratings that give information about the quality of the products and services they offer. Wouldn’t it be helpful to have the same kind of ratings when choosing a health care provider?

It can be overwhelming when consumers are faced with having to choose a health care provider, such as a hospital, nursing home, or physician. Providers differ in the safety and quality of care they give, and having quality ratings available to compare providers can help consumers make more informed health care decisions. That’s why the Centers for Medicare & Medicaid Services (CMS) is committed to making it easier to use the information on our Compare sites.  

Later this year and early in 2015, we’re adding a star rating system to the Hospital Compare, Dialysis Facility Compare, and Home Health Compare websites on The Compare sites are the official CMS source for information about the quality of health care providers, and the star rating system is just one of many ways we’re working to make quality information easier to understand and compare. These ratings are based on established scientific standards of rigor and accuracy. Our Nursing Home Compare site already uses star ratings to help consumers compare nursing homes and choose one based on quality. Physician Compare has just started to include star ratings in certain situations for physician group practices.

While consumers are the main audience for the Compare sites, stakeholders and partners can visit and use the same data that power the Compare websites in easy-to-use formats. We’re excited to make this available so that you can use the same set of authoritative data in your work. CMS is committed to providing useful and current quality performance data. The star ratings empower consumers with information to make more informed health care decisions, encourage providers to strive for higher levels of quality, and drive overall health system improvement.

Open Payments Data Collection Moves Forward

By Dr. Shantanu Agrawal, CMS Deputy Administrator and Director of Center for Program Integrity

By now, you may have heard about the Open Payments program (previously known as the Sunshine Act) and wondered what it is and what it means for you. This program offers patients the opportunity to know if their doctors have a financial relationship with companies that make or supply medicines, medical supplies or devices, and the biological products used in their care. Disclosure of these relationships will allow patients to be more informed health care consumers.

In this first year of the Open Payments program, health care manufacturing companies and group purchasing organizations (GPOs) will report the financial interactions they had with physicians and teaching hospitals in the last five months of 2013. These payments could include things like compensation for meals, travel, gifts, consulting, and research and are reported to CMS by industry companies. We are already encouraged by the high rate of preliminary industry data submission and expect a similarly high level of industry engagement when detailed data submission starts on Sunday, June 1. The submission period ends at the close of business Monday, June 30.

CMS is taking steps to ensure that information made public is accurate and has engaged stakeholders as pilot users to ensure that reporting systems are user-friendly and performing properly. Physicians and teaching hospitals will be able to review data submitted by the manufacturers and GPOs, and if needed, they should report and dispute inaccuracies before the data is included in the public database. They can review the information submitted about them prior to public posting by registering in our Enterprise Portal starting June 1, 2014, and then registering in the Open Payments system in July.

We’re committed to health data transparency that the Open Payments program provides. Thanks to the Affordable Care Act, this fall, we’ll have this powerful new tool that offers consumers additional information to make choices about their health care. Every year CMS will continue to release financial relationship information between health care providers and the industry as it becomes available about the prior year (e.g. by June 30, 2015 for 2014 data). Learn more at

Interactive Tool Allows Easier Access Data on Physicians

Author: Niall Brennan, Acting Director, Offices of Enterprise Management

Today, the Centers for Medicare & Medicaid Services (CMS) released a new interactive search tool that can help consumers and other stakeholders navigate information about the types of medical services and procedures delivered by physicians and other healthcare professionals. Users can search for a provider by name, address, or National Provider Identifier (NPI). Once a user selects a provider, the tool returns information about the services the provider furnished to Medicare beneficiaries, including the number of services provided, the number of beneficiaries treated, and the average payment and charges for such services.

This new look-up tool makes it easier to use the large data set about physician information that CMS released on April 9, 2014 to look up specific providers. As with the data set, the look-up tool does not include information for cases where a provider administered a particular service 10 or fewer times to ensure the confidentiality of patients’ personal information. In addition, the information in the look-up tool only reflects the services provided to Medicare fee-for-service beneficiaries and does not include measurements of the quality of care provided by a provider.

The release of this data set provides unprecedented access to information on the types of services physicians and other healthcare professionals deliver under the Medicare program. Within the first week of posting the data, more than 150,000 users downloaded the data, and the CMS website where the data is posted had nearly 250,000 page views.

This is the next step in our effort to provide useful, privacy-protected data to improve transparency as well as the quality and affordability of health care in this country.

Historic release of data delivers unprecedented transparency on the medical services physicians provide and how much they are paid

By Jonathan Blum, Principal Deputy Administrator, Centers for Medicare & Medicaid Services

Today the Centers for Medicare & Medicaid Services (CMS) took a major step forward in making Medicare data more transparent and accessible, while maintaining the privacy of beneficiaries, by announcing the release of new data on medical services and procedures furnished to Medicare fee-for-service beneficiaries by physicians and other healthcare professionals ( For too long, the only information on physicians readily available to consumers was physician name, address and phone number. This data will, for the first time, provide a better picture of how physicians practice in the Medicare program.

This new data set includes over nine million rows of data on more than 880,000 physicians and other healthcare professionals in all 50 states, DC and Puerto Rico providing care to Medicare beneficiaries in 2012. The data set presents key information on the provision of services by physicians and how much they are paid for those services, and is organized by provider (National Provider Identifier or NPI), type of service (Healthcare Common Procedure Coding System, or HCPCS) code, and whether the service was performed in a facility or office setting. This public data set includes the number of services, average submitted charges, average allowed amount, average Medicare payment, and a count of unique beneficiaries treated. CMS takes beneficiary privacy very seriously and we will protect patient-identifiable information by redacting any data in cases where it includes fewer than 11 beneficiaries.

Previously, CMS could not release this information due to a permanent injunction issued by a court in 1979. However, in May 2013, the court vacated this injunction, causing a series of events that has led CMS to be able to make this information available for the first time.

Data to Fuel Research and Innovation

In addition to the public data release, CMS is making slight modifications to the process to request CMS data for research purposes. This will allow researchers to conduct important research at the physician level. As with the public release of information described above, CMS will continue to prohibit the release of patient-identifiable information. For more information about CMS’s disclosures to researchers, please contact the Research Data Assistance Center (ResDAC) at

Unprecedented Data Access

This data release follows other CMS efforts to make more data available to the public. Since 2010, the agency has released an unprecedented amount of aggregated data in machine-readable form, with much of it available at These data range from previously unpublished statistics on Medicare spending, utilization, and quality at the state, hospital referral region, and county level, to detailed information on the quality performance of hospitals, nursing homes, and other providers.

In May 2013, CMS released information on the average charges for the 100 most common inpatient services at more than 3,000 hospitals nationwide

In June 2013, CMS released average charges for 30 selected outpatient procedures

We will continue to work toward harnessing the power of data to promote quality and value, and improve the health of our seniors and persons with disabilities.


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