The Centers for Medicare & Medicaid Services (CMS) established the Physician Compare website in January 2011 to help patients locate and obtain data regarding physicians who participate in the Medicare program. CMS is using a phased-in approach for the physician information that the agency publicly reports on the website. For example, in 2017 more physician information pertaining to the value-based payment modifier (VM) will be included on the website than in 2016. The information on Physician Compare is generally derived using data from the previous year; thus, information appearing on the site in 2017 will be based on 2016 physician data. This column addresses questions surgeons may have about new information they can expect to find on the Physician Compare website in 2016.
Where does CMS get its information, and what kind of information is reported about me?
CMS will share data from multiple sources. Beginning this year, CMS is 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 more information about the various PQRS reporting options online.)
In addition, information will be available from the 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 codes to describe services and procedures rendered. (See Table 1).
Table 1. Summary of timeline and data available for Physician Compare
| Data collection year | Public reporting year | Data type | Reporting mechanism |
| 2015 | 2016 |
PQRS—Group practices |
Web interface (WI), electronic health records (EHR), registry, claims, Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (CAHPS) |
| 2015 | 2016 |
PQRS—Individual eligible professionals (EPs) |
Registry, EHR, claims, qualified clinical data registry (QCDR) |
| 2015 | 2016 |
Medicare Shared Savings Program Accountable Care Organizations (ACOs) |
WI, survey vendor, administrative claims |
| 2016 | 2017 |
PQRS—Group practices |
WI, EHR, registry, claims, CAHPS, QCDR |
| 2016 | 2017 |
PQRS—Individual EPs |
Registry, EHR, claims, QCDR |
| 2016 | 2017 |
Utilization data |
Claims |
| 2016 | 2017 |
VM |
This information will be made available either on a physician’s profile page, or available for download. PQRS measures information will be split between the formats. CMS has yet to determine which PQRS measures will be available in which format, but VM information will be available for download.
What does the star rating on my profile mean?
CMS will publicly report measure-level benchmarks derived using the achievable benchmark of care (ABC) methodology based on PQRS performance. The ABC methodology evaluates who the top-performing providers are and then uses that ranking to set a point of comparison for all of those groups or individual providers who report the same measure. CMS will use the ABC methodology to systematically apply a five-star rating to the measures. Find more information about the ABC methodology online.
Are the measure results that are posted statistically valid and reliable?
Before measures are posted, CMS performs reliability and validity testing. In addition, measures must have a minimum sample size of 20 patients and “resonate with consumers,” which means they have been consumer tested. New measures are not reported until after their first year of use in PQRS.
If I participate in PQRS, when will the data be posted on Physician Compare?
Physician Compare reports the previous year’s 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. To report an error in the information, physicians should notify CMS at PhysicianCompare@Westat.com. Issues raised must be addressed 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)—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.
For more information about Physician Compare, visit the CMS website, or e-mail the agency at PhysicianCompare@Westat.com.
