Physician Compare Overview
What is Physician Compare?
What information is available on Physician Compare?
How does CMS decide what to post on Physician Compare?
What are the plans for public reporting of quality of care data on Physician Compare?
How are CMS’ quality programs related to Physician Compare?
Physician Compare Statutory Authority
The Centers for Medicare and Medicaid Services (CMS) was required by Section 10331 of the Patient Protection and Affordable Care Act (ACA) of 2010 to establish the Physician Compare website. As a result, the site was launched on December 30, 2010. In its first iteration, Physician Compare utilized the existing Healthcare Provider Directory already part of Medicare.gov. Since that time, CMS has been working continually to enhance the site and its functionality, improve the information available, and include more and increasingly useful information about physicians and other healthcare professionals who take part in Medicare. This effort, along with the eventual addition of quality measures on the site, will help it serve its two-fold purpose
- To provide information for consumers to encourage informed healthcare decisions; and
- To create explicit incentives for physicians to maximize performance.
Currently, Physician Compare is a website that allows consumers to search for physicians and other healthcare professionals who provide Medicare services. Some of the information on the site includes:
- Physicians’ and other healthcare professionals’ names, addresses, phone numbers, specialties, clinical training, and genders.
- If physicians and other healthcare professionals speak languages other than English.
- The hospitals physicians and other healthcare professionals are affiliated with.
- If physicians and other healthcare professionals accept the Medicare-approved amount (patient will not be billed for any more than the Medicare deductible and coinsurance).
- Group practice information including their location addresses, phone numbers, maps and directions, specialties, as well as a list of physicians and other healthcare professionals within that practice.
CMS uses feedback from the public and stakeholders through Town Hall meetings, Listening Sessions, e-mail received at PhysicianCompare@Westat.com, and the rulemaking process to define the scope and direction of Physician Compare. Through rulemaking, CMS proposes new policies, including what type of information will be publicly reported on Physician Compare in what years, and the public is provided the opportunity to comment on these proposals and give CMS their opinion.
CMS has begun to implement a plan to make quality data available on Physician Compare. The Affordable Care Act (ACA) required the plan be established by January 1, 2013. The first step in this plan was outlined in the 2012 Physician Fee Schedule (PFS) Final Rule initiating a phased approach to public reporting. The second step as outlined in the 2013 PFS Final Rule furthers the plan to add quality data and other information to Physician Compare. According to this plan, CMS will post the first set of measure data on the site in calendar year 2014, reflecting data collected no sooner than program year 2012. These data will include Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO) measures for group practices and Accountable Care Organizations (ACOs).
The plan for Physician Compare also includes publically reporting patient experience data, such as the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) measures, for ACOs and group practices of 100 or more eligible professionals participating in the 2013 PQRS GPRO as soon as technically feasible, but not before calendar year 2014.
Physician Compare includes information about physicians and other healthcare professionals who satisfactorily participate in CMS quality programs.
The Physician Quality Reporting System (PQRS) is a pay-for-reporting program that gives eligible professionals incentives and payment adjustments if they report quality measures satisfactorily. Although PQRS is a standalone program, it touches on other CMS programs that require quality reporting, such as the eRx Incentive Program, the EHR Incentive Program, the Medicare Shared Savings Program, and the Value-based Payment Modifier. This Medicare program encourages physicians and other healthcare professionals to report information about the quality of the care they provide to people with Medicare who have certain medical conditions. Physicians and other healthcare professionals can choose whether to report quality information through PQRS. Profile pages show whether physicians and other healthcare professionals have taken part in PQRS.
The Electronic Prescribing (eRx) Incentive Program is a pay-for-reporting program that encourages physicians and other healthcare professionals to use electronic prescribing to improve communication, increase accuracy, and reduce errors. To participate in this Medicare program, physicians and other healthcare professionals must report on their use of a qualified eRx system. Profile pages show if physicians and other healthcare professionals are participating in the eRx Incentive Program.
The Electronic Health Record (EHR) Incentive Program is a Medicare program that provides incentives and payment adjustments to eligible professionals who use certified EHR technology in ways that may improve healthcare. Profile pages will show if physicians and other healthcare professionals are participating in the EHR Incentive Program.
Excerpt from CY 2015 PFS Final Rule (Discussion about Physician Compare background and Statutory Authority). 79 FR 67767 (Nov. 13, 2014)
Section 10331(a)(1) of the Affordable Care Act, requires that, by no later than January 1, 2011, we develop a Physician Compare Internet Website with information on physicians enrolled in the Medicare program under section 1866(j) of the Act; as well as information on other eligible professionals (EPs) who participate in the Physician Quality Reporting System (PQRS) under section 1848 of the Act.
Building off the Physician and Other Health Care Professional Directory, CMS launched the website and the first phase of Physician Compare on December 30, 2010 ( Physician Compare Website - Opens in a new window ). In the initial phase, we posted the names of EPs that satisfactorily submitted quality data for the 2009 PQRS, as required by section 1848(m)(5)(G) of the Act.
Section 10331(a)(2) of the Affordable Care Act also requires that, no later than January 1, 2013, and for reporting periods that began no earlier than January 1, 2012, we implement a plan for making publicly available through Physician Compare information on physician performance that provides comparable information on quality and patient experience measures. We met this requirement in advance of January 1, 2013, and outlined a plan to post on Physician Compare physician performance data and in particular, use the existing PQRS as an initial step for making physician measure performance information available. Under this plan, we use a phased-in approach and disclose physician performance and patient experience data in stages. In addition, we address elements of the plan and aspects of Physician Compare through rulemaking.
To the extent that scientifically sound measures are developed and are available, section 10331(a)(2) of the Affordable Care Act requires that we include, to the extent practicable, the following types of measures for public reporting:
- Measures collected under the Physician Quality Reporting System (PQRS).
- An assessment of patient health outcomes and functional status of patients.
- An assessment of the continuity and coordination of care and care transitions, including episodes of care and risk-adjusted resource use.
- An assessment of efficiency.
- An assessment of patient experience and patient, caregiver, and family engagement.
- An assessment of the safety, effectiveness, and timeliness of care.
- Other information as determined appropriate by the Secretary.
As required under section 10331(b) of the Affordable Care Act, in developing and implementing the plan, we must include, to the extent practicable, the following:
- Processes to ensure that data made public are statistically valid, reliable, and accurate, including risk adjustment mechanisms used by the Secretary.
- Processes for physicians and EPs whose information is being publicly reported to have a reasonable opportunity, as determined by the Secretary, to review their results before posting to Physician Compare. We have established a 30-day preview period for all measurement performance data that will allow group practices, physicians, and other EPs, to view their data as it will appear on the website in advance of publication on Physician Compare (77 FR 69166 and 78 FR 74450). Details of the preview process will be communicated directly to those with measures to preview and will also be published on the Physician Compare Initiative page (http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/physician-compare-initiative/) in advance of the preview period.
- Processes to ensure the data published on Physician Compare provides a robust and accurate portrayal of a physician's performance.
- Data that reflects the care provided to all patients seen by physicians, under both the Medicare program and, to the extent applicable, other payers, to the extent such information would provide a more accurate portrayal of physician performance.
- Processes to ensure appropriate attribution of care when multiple physicians and other providers are involved in the care of the patient.
- Processes to ensure timely statistical performance feedback is provided to physicians concerning the data published on Physician Compare.
- Implementation of computer and data infrastructure and systems used to support valid, reliable and accurate reporting activities.
Section 10331(d) of the Affordable Care Act requires us to consider input from multi-stakeholder groups, consistent with sections 1890(b)(7) and 1890A of the Act, when selecting quality measures for Physician Compare. We also continue to get general input from stakeholders on Physician Compare through a variety of means, including rulemaking and different forms of stakeholder outreach (for example, Town Hall meetings, Open Door Forums, webinars, education and outreach, Technical Expert Panels, etc.). In developing the plan for making information on physician performance publicly available through Physician Compare, section 10331(e) of the Affordable Care Act requires the Secretary, as the Secretary determines appropriate, to consider the plan to transition to value-based purchasing for physicians and other practitioners that was developed under section 131(d) of the MIPPA.
Under section 10331(f) of the Affordable Care Act, we are required to submit a report to Congress by January 1, 2015, on Physician Compare, including information on the efforts and plans to collect and publish data on physician quality and efficiency and on patient experience of care in support of value-based purchasing and consumer choice. Section 10331(g) of the Affordable Care Act provides that any time before the date on which the report is submitted, we may expand (including expansion to other providers of services and suppliers under title XVIII of the Social Security Act) the information made available on Physician Compare. We have decided not to expand the Physician Compare website prior to the submission of this report to other providers and suppliers, beyond physicians and other EPs. In addition, while the scope of the website will continue to address the types of information referenced in section 10331 of the Affordable Care Act, Physician Compare will be updated on a periodic basis with new measures and updated measure data and information. We believe section 10331 of the Affordable Care Act supports our overarching goals of providing consumers with quality of care information that will help them make informed decisions about their health care, while encouraging clinicians to improve the quality of care they provide to their patients. In accordance with section 10331 of the Affordable Care Act, and consistent with the plan we developed and implemented for Physician Compare, we plan to continue to publicly report physician performance information on Physician Compare. We plan to publicly report physician performance information, including comparative information on quality, efficiency, and patient experience, on Physician Compare.
Using our phased-in approach, the particular data sources for such information will be identified and posted on Physician Compare consistent with the processes we’ve previously established (e.g., engage stakeholder input through a variety of means; conduct rulemaking regarding specific data sets, publish data on the website in a subsequent year after performing statistical and validity analyses to assess reliability and validity, etc.).
E-mail feedback and questions to the Physician Compare team at PhysicianCompare@Westat.com.
- Page last Modified: 12/19/2014 11:23 AM
- Help with File Formats and Plug-Ins