American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Physician Compare Website

Developed as part of the Patient Protection and Affordable Care Act (ACA) of 2010 to increase transparency by publicly reporting data on providers, the Centers for Medicare and Medicaid Services (CMS) designed the Physician Compare website to help patients obtain data about Medicare-participating physicians. The website was created to provide information for consumers interested in making informed healthcare decisions. CMS is using a phased-in approach for the physician information that the agency publicly reports on the website. Physician Compare has been through multiple iterations since it launched in 2011.

What source of data does CMS rely on to populate Physician Compare?              

CMS will use data from multiple sources. Quality measure data reflects data submitted by clinicians via claims, qualified registry, qualified clinical data registry (QCDR), the Web Interface, or CAHPS for MIPS. Basic provider information, such as names, addresses, phone numbers, specialties, education and group affiliation, will come from the Provider Enrollment, Chain, and Ownership System (PECOS). CMS will also use claims data to verify practice location and group and hospital affiliations. Finally, CMS will rely on data from national certifying boards to confirm board certification.

If you have recently switched group practices, it is important that you officially sever your relationship with the former group practices through PECOS to ensure that data reported on Physician Compare only reflects your most current practice affiliation. Visit the CMS website for more information on how to update your info on Physician Compare.

What kind of quality data will be available in 2018?

In late 2018, CMS will make the following data available to the public via Physician Compare:

  • 2017 MIPS Quality Scores
  • 2017 MIPS Improvement Activities (IA) Scores
  • 2017 MIPS Advancing Care Information (ACI) Scores
  • 2017 MIPS Cost
  • 2017 MIPS Final Score

Current quality and performance data found on Physician Compare was collected from various CMS quality programs. The following data is available to the public via Physician Compare: 

  • 2016 group PQRS measures reported as star ratings
  • 2016 group CAHPS for PQRS summary survey measures reported as top-box scores
  • 2016 non-PQRS QCDR group and clinician measures reported as performance scores
  • 2016 ACO measures reported as performance scores
  • 2016 CAHPS for ACO summary survey measures reported as average (mean) scores

In 2017, CMS began to report a subset of PQRS quality measure data using a 5-star rating system that reflects benchmarked performance rates. Star ratings will only apply to a subset of quality measures reported in 2016 by group practices via a qualified registry or the Web Interface. Impacted measures include:

  • PQRS #06: Giving antiplatelet blood thinners to patients with heart disease
  • PQRS #47: Older patients who have an advanced care plan
  • PQRS #48: Evaluating loss of bladder control in older women
  • PQRS #51: Spirometry evaluation in patients with COPD
  • PQRS #110: Getting a flu shot during flu season
  • PQRS #111: Making sure older adults have gotten a pneumonia vaccine
  • PQRS #113: Screening for colorectal (colon or rectum) cancer
  • PQRS #117: Eye exam for patients with diabetes
  • PQRS #128: Screening for an unhealthy bodyweight and developing a follow-up plan
  • PQRS #134: Screening for depression and developing a follow-up plan
  • PQRS #226: Screening for tobacco use and providing help quitting when needed
  • PQRS #238.1: Limiting high-risk medicine use in older adults
  • PQRS #318: Screening older patients’ risk of falling
  • PQRS #321: CAHPS for PQRS

Physician Compare also will include measures reported by the Medicare Shared Savings Program, as well as indicate if a group practice is affiliated with an ACO(s).

Lastly, Physician Compare will report clinician-level utilization data generated from Medicare Part B claims using Healthcare Common Procedure Coding System (HCPCS) codes to describe services and procedures rendered. The dataset, called the Physician Compare Utilization Data, is a downloadable file containing a subset of HCPCS codes that is searchable by name, NPI, location, and specialty. The HCPCS codes included in the dataset refer to a subset of HCPCS codes and focuses on the top 5 codes for each specialty. The dataset does not include E/M codes. 

Please note: New PQRS data will no longer be posted to the Physician Compare website after 2017, due to the replacement of the PQRS program by the Quality Payment Program.  Starting in late 2018, CMS will begin to report physician performance data related to the new Quality Payment Program (QPP).

Are the measure results that are posted statistically valid and reliable?

Only measures that meet the CMS statistical public reporting standards will be available for public reporting on physician and group practice profile pages and/or the Physician Compare Downloadable Database. The CMS statistical public reporting standards require CMS deems the measures be valid, reliable, accurate, and comparable. A minimum sample size of 20 patients is also required for performance information to be included on Physician Compare. CMS will only post a subset of these performance data on physician profile pages if it was found to “resonate with users.”

New measures are not reported until after their first year of use in MIPS. While the American College of Surgeons (ACS) believes that transparency is key, we have consistently voiced concerns to CMS about the broad application of a 20-patient sample size to determine validity and reliability, and that reliability and validity must be determined on a measure-by-measure basis. Otherwise, results posted by CMS could result in the misclassification of surgical care. As CMS transitions to more widespread reporting of physician performance data on Physician Compare it is critical that it improve current explanations regarding the data, descriptions about calculations and benchmarks, and disclaimers about the limitations of the data.

If I participate in PQRS, when will the data be posted on Physician Compare?

Physician Compare reports the previous year’s PQRS data. For example, 2017 PQRS data will appear on Physician Compare in 2018.

Can I preview my information before it is made public on Physician Compare?

Yes, CMS provides a 30-day preview period before posting measures on Physician Compare. A resource toolkit is available to help you navigate the 2017 Physician Compare preview period. Download these resources from the Physician Compare Initiative page:

Note:  You must have the correct Enterprise Identity Management (EIDM) account and appropriate user role to access the Provider Quality Information Portal (PQIP), where you can preview your measures (an EIDM account is not required to use the Lookup Tool). CMS encourages you to verify that you have an active EIDM account and the correct user roles as early as possible. Learn more about EIDM and user roles in the Physician Compare Guide to Preview. To request the correct user role, or for assistance with your EIDM account or information, contact the QualityNetHelp Desk: 866-288-8912, TTY: 877-715-6222, qnetsupport@hcqis.org.

CMS encourages physicians to preview their data as early as possible to ensure they see the performance data before it is published on Physician Compare.

If you identify an error or issue with your previewed data, please notify CMS at PhysicianCompare@Westat.com.

For more information about Physician Compare, please contact Bobby Kopp or visit the CMS Website.