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.
Where does CMS get its information, and what kind of information is reported about me?
CMS will share data on providers from multiple sources. Basic provider information such as names, addresses, phone numbers, specialties, training, and hospital affiliations, will come from the Provider Enrollment, Chain, and Ownership System (PECOS). Beginning in 2016, both groups and individual providers will be posted on Physician Compare. CMS is also releasing all of the Physician Quality Reporting System (PQRS) data for measures on which a physician reports, regardless of the reporting option used to participate in the program. Find out more information on PQRS reporting options.
In addition, information will be available from the Value-Based Payment Modifier (VM) program, which is based on both the quality and cost of care a physician provides to Medicare beneficiaries. For 2016, the VM cost and quality tiers will reflect performance in 2014. Physician Compare also will include all measures reported by the Medicare Shared Savings Program, as well as indicate physicians who support the U.S. Department of Health and Human Services Million Hearts initiative.
Lastly, Physician Compare will report utilization data generated from Medicare Part B claims using Healthcare Common Procedure Coding System (HCPCS) codes to describe services and procedures rendered.
Are the measure results that are posted statistically valid and reliable?
Before measures are posted, CMS makes efforts to confirm validity and reliability by ensuring measures have a minimum sample size of 20 patients and “resonate with consumers.” New measures are not reported until after their first year of use in PQRS. 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. In general, 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, 2016 PQRS data will appear on Physician Compare in 2017. However, the 2018 VM will reflect 2016 data and be included on the site late in 2017 at the earliest.
Can I preview my information before it is made public on Physician Compare?
Yes, CMS provides a 30-day preview period before posting the measures on Physician Compare. CMS will alert providers directly using the contact information provided at the time of PQRS registration. To report an error in the information, physicians should notify CMS at PhysicianCompare@Westat.com. Providers must address issues raised prior to public reporting as Physician Compare does not have an appeals process.
Physicians also may preview their VM tier using the Quality and Resource Use Reports (QRURs). QRURs are confidential feedback reports that provide information about the resources used (cost) and the quality of care physicians and group practices provide to Medicare fee-for-service patients. The QRUR can be accessed on the CMS website.
ACS is very concerned regarding the fact that physicians are currently inundated with information related to quality reporting program requirements. With the competing demands and the concerns highlighted earlier, ACS is aware that 30 days is simply too short of a time period for physicians to access reports, review their data, identify any potential errors or other misinformation, and gather the evidence needed to refute erroneous data. Therefore, we have developed multiple resources to help surgeons understand this process including a Bulletin article with what to expect for 2016. We are also available via email or on the phone. For more information about Physician Compare please contact Molly Peltzman or visit the CMS website.
Bulletin Articles on Physician Compare