CMS Bolsters Physician Website for Greater Utility, Quality Reporting

A revamped version of the Physician Compare website -- the Centers for Medicare & Medicaid Services’ (CMS) public platform for presenting comparative physician information–will be launched in March with enhanced functionality and the ability to support an ever-increasing array of quality measures.

Physician Compare was mandated by the Patient Protection and Affordable Care Act (ACA) and launched in late 2010. Since then, CMS has worked to increase the site’s functionality, improve its information and establish a sustainable framework for the ACA’s long-term quality reporting requirements.

The site’s primary objectives are both to provide information aimed at encouraging informed consumer healthcare decisions and to create explicit incentives for physicians to maximize performance, according to CMS.

“As we move forward with Physician Compare, we will continue to develop and improve the site over time,” said Lisa Lentz, a health insurance specialist with CMS, during a CMS webinar with physicians in early January. “Based on your feedback -- feedback we receive through various vehicles, including Physician Fee Schedule rule comment, e-mail, outreach, and consumer testing -- we will work to continue to advance the site and ensure it is as accurate, current, user-friendly and as high-functioning as possible.”

Built on PECOS

Physician Compare was developed using the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) as the underlying data source. With the re-launch in March, the site will also harness Medicare claims data to ensure that information is accurate and that only active physicians are included in the database.

Enhancements made to Physician Compare since its inception include the addition of information about physicians’ participation in the Electronic Prescribing Incentive Program and the Physician Quality Reporting System (PQRS), as well as hospital affiliation.

Currently, users can search for physicians and other healthcare professionals by entering a city and state or zip code. Available information includes:

  • Physicians’ and other healthcare professionals’ names, genders, addresses and phone numbers;
  • Primary and secondary specialties and accepting new Medicare patient status as indicated in PECOS;
  • Medical school and clinical training;
  • Whether physicians or healthcare professionals speak languages other than English;
  • The group practices physicians are affiliated with;
  • Whether the physician accepts Medicare Assignment, which ensures that a patient will not be billed for any more than the Medicare deductible and coinsurance.

Intelligent Searching

With the re-launch of Physician Compare in March, new search capabilities will allow users to more effectively focus on specialties and also conduct searches based on condition, body part, organ system or other keyword. CMS contractors have solicited input from specialty societies for terms to include in the new search functionality, and they will continue to seek feedback while working to improve the crosswalk of key words as the site is regularly updated over time.

To help improve accuracy, a new feature in PECOS also will allow physicians to limit their group practice affiliation to a single primary and single secondary address. In the past, Physician Compare linked physicians to every affiliated group address included in PECOS. This proved problematic for members of large groups that spanned wide geographic areas and also for users, who may have thought they’d identified a provider nearby but who actually practiced hundreds of miles away. Currently, professionals and their group practice administrators can log onto PECOS and set the primary and secondary addresses.

Quality Reporting Timeline

Quality measure rating and reporting – ultimately the central aim of the Physician Compare site -- will be phased in over the next several years, per mandates of the ACA. Reporting will initially focus on group practices and Accountable Care Organizations (ACOs). The first data to be publically reported will be the Physician Quality Reporting System Group (PQRS) Practice Reporting Option (GPRO) measure collected via the GPRO web interface. CMS is targeting reporting 2012 GPRO measures on Physician Compare for both group practices and ACOs in early 2014.

CMS also plans to develop and publish composite scores for groups and ACOs at the disease module level, specifically for the GPRO Diabetes Mellitus and Coronary Artery Disease measures. Data for program year 2013 is expected to be published in calendar year 2014.

Because patient experience information is considered essential to an effective quality reporting system, a measure called Clinical & Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) will be published on the site in 2014. Data to support the measure will be collected via a survey of ACOs and group practices of 100 physicians or more in 2013.

A proposal to publicly report measures that have been developed and collected by approved specialty societies was included in the 2013 Physician Fee Schedule Final Rule. Currently, no specific timeline is associated with these measures, and CMS plans to work with specialty societies to identify the most appropriate data sources and mechanisms for inclusion on the website. Among other things, the measures will allow specialties not currently represented by available PQRS measures to have information presented for public reporting on Physician Compare.

Finally, CMS is working toward reporting the individual physician performance on PQRS and claims-derived quality measures, with a target date for posting this information of 2015. The specific measures to be posted will be addressed in future rule making.

“It is important that consumers are not overwhelmed by a large number of quality measures on Physician Compare,” said CMS’ Lentz in the January webinar. “For this reason, we will work very closely with stakeholders and consumers to ensure the information included on the site truly helps consumers make informed healthcare decisions.”

To display ratings for group practices, ACOs and ultimately physicians, CMS is considering using a consumer-friendly star rating system. However, no final decision on that issue has been made, according to Lentz.

“As we move toward publicly reporting quality measures on Physician Compare, I want to assure you that we are committed to making sure all data are statistically valid and reliable, and include risk adjustment where appropriate,” she said.

“CMS is striving to post robust data that are an accurate portrayal of a physician’s performance. And we look forward to continuing a dialogue with you as we move forward with our measure selection process and further evolve our plans for public reporting on Physician Compare.”



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