As required under the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) established the Physician Compare website in January 2011. This site currently features information on Medicare physicians and other eligible professionals (EPs) who participate in the Physician Quality Reporting System (PQRS).
In the 2013 Medicare Physician fee schedule (MPFS) final rule, CMS lays out a framework for expanding the website by collecting information on physician quality, efficiency, patient experience of care, and how such information will be made available on Physician Compare. This column details how CMS’ plan may impact surgeons. For additional information on the Physician Compare website, visit the Medicare website.
What type of information is CMS currently posting on the Physician Compare website?
CMS lists basic provider information as well as information on whether a provider has successfully participated in the PQRS program and/or Electronic Prescribing (eRx) Incentive Program. CMS collects basic provider information through the Medicare Provider Enrollment, Chain, and Ownership System (PECOS), making it imperative that the information a provider has on file in the PECOS system is up to date and accurate.
Using Physician Compare, EPs may obtain definitive information about physicians and other health care professionals by selecting a location and specialty. The results provide information on specialty, practice locations, group practice and hospital affiliations, Medicare assignment status, education, languages spoken, gender, and so on.
The ACA also mandates that CMS use the most recent incentive program information to indicate whether a professional has satisfactorily participated in the PQRS program and/or is a successful electronic prescriber under the eRx Incentive Program.
CMS is planning to include updated administrative information on an EP’s page as well as information regarding physician performance. CMS plans to enhance the administrative data by adding information on whether a physician or other health care professional is accepting new Medicare patients, board certification information, improved foreign language, and hospital affiliation data. CMS also intends to include the names of EPs who are successfully participating in the PQRS, the PQRS Maintenance of Certification bonus program, and the eRx Incentive Program. When feasible, CMS will post the names of EPs who are successfully participating in the Electronic Health Record (EHR) Incentive Program. As noted in the 2013 MPFS final rule, CMS will display an indicator on the profile Web page of an EP to acknowledge satisfactory participation in the incentive programs.
Under the ACA, CMS is required to implement a plan no later than January 1, 2013, and make publicly available on the Physician Compare website information on physician performance that provides comparable quality and patient experience measures. The 2013 fee schedule finalized CMS’ plan to use data from the existing PQRS program as a first step toward making physician measure performance information public on Physician Compare. CMS has finalized the decision to make public on Physician Compare, beginning later in 2013 or early 2014, the performance rates on the quality measures that group practices submit under the 2012 PQRS group practice reporting option Web-interface and the Medicare Shared Savings Program, as well as patient experience of care data.
Moreover, CMS will only post quality measure information on groups of 100 or more EPs and must meet a sample size of 20 patients who prove to be statistically valid and reliable. To ensure that the data are statistically valid, CMS will not report on a measure if a measure meeting the minimum threshold is invalid or unreliable for any reason. Additionally, CMS plans to post on the Physician Compare website in 2014 several composite measures that reflect group performance across related measures. CMS also intends to work with specialty societies in the future to include specialty society data that are already collected for other purposes and go through appropriate testing. Lastly, CMS plans to post information on individual-level data beginning in 2015 but will address the details of doing so in future rulemaking.
How will Physician Compare impact me?
Although CMS will start posting physician performance and patient experience of care data in 2014, they will begin by only posting information on groups of 100 or more EPs. Before posting the patient experience of care data, CMS will provide group practices and accountable care organizations with a 30-day period to preview their quality data and how it will appear on the Physician Compare website. Eventually, CMS will include individual-level data on Physician Compare, and specific details on how this information will be presented will be decided in future rulemaking. EPs are encouraged to regularly check their profiles to ensure the accuracy of the information being provided.
Should there be any errors, providers are encouraged to log in to their PECOS account. For more information on PECOS accounts, visit the Medicare website. By providing consumers with quality-of-care information, CMS’ goal is to help consumers make informed decisions about their health care and also encourage clinicians to improve the quality of care that they provide to their patients.