Quality Data and the Physician Compare Website: What You Need to Know

Lisa Greene authored this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of Falcon, LLC or DaVita, Inc.

The Physician Compare website was created by CMS as required by the Patient Protection and Affordable Care Act (ACA) of 2010. The goal of the site is to provide useful information to patients and help them make informed decisions about their health care.  When the site first launched in December of 2010, it was nothing more than a searchable database of physicians and other healthcare professionals that participate in Medicare. Today, Physician Compare displays basic profile information including practice location, phone number, gender, specialty, medical school education, board certification, hospital affiliation and languages spoken.  Over the past several years, CMS has been expanding the information available on the site and is working to publicly report quality and cost data as another mechanism for physician comparison.

Presently, CMS notes whether or not a doctor participated in The Physician Quality Reporting System (PQRS) along with their performance on certain quality measures.  CMS determines which quality measures to display and will only display those measures which the agency deems statistically valid and reliable and suitable for public reporting.  Information related to the Merit-based Incentive Payment System (MIPS) including data for each of the MIPS performance categories (Quality, Cost, Advancing Care Information and Improvement Activities) could be posted as early as 2019 based on the 2017 performance scores.

It is important that physicians visit the Physician Compare website and review both their practice information and any PQRS data for accuracy. Basic profile information is taken directly from the Medicare Provider Enrollment, Chain, and Ownership System (PECOS), so make sure your data in the PECOS system is up to date.  Performance on quality measures is graphically represented by a star rating system.  Each star represents 20% (5 stars = 100%, 4 stars=80% etc.) and corresponds to the percentage of your performance on a particular measure.  In late 2017, CMS plans to report all of the 2016 PQRS measures collected as well as benchmarks to provide context and an additional point of comparison.  CMS offers a 30 day preview period before measures are posted.  They will contact physicians directly and announce the preview period via the Physician Compare listserv, the MLN Provider eNews as well as other outreach methods.  Physicians can also review their Quality and Cost data in their Quality and Resource Use Reports (QRURs) which can be accessed on the CMS website.

Overall, our decisions to buy certain products or services are influenced by the experiences and opinions of others.  We seek advice from family and friends and have hundreds of websites at our disposal to conduct research and make comparisons.  The Physician Compare website is becoming the Consumer Reports for health care.  Physicians need to be aware of and monitor the information that is being published as it reflects on their reputation and may influence potential patients to either seek out or avoid a practice.

If you discover errors on the Physician Compare website, you can report them to PhysicianCompare@Westat.com.  You can also visit the How to Update your Data on Physician Compare FAQ page.   Be sure to identify and report errors during the 30 day preview period as there is no formal appeals process.  Also note, any edits made in the PECOS system can take two to four months to be reflected on Physician Compare.

About the Author:

LisaGreene     Lisa Greene joined DaVita in 2014 and has held roles in Business Development and Strategy.  She is currently a Product Manager for Falcon Physician and is the lead for the internal MACRA Center of Excellence.