About Physician Compare: An Overview
What is Physician Compare?
What information is available on Physician Compare?
What is the history of public reporting performance information on Physician Compare?
What is Physician Compare’s Statutory Authority?
The Physician Compare website was created in December 2010 as required by the Affordable Care Act (ACA) of 2010. The Medicare and CHIP Reauthorization Act of 2015 (MACRA) provided additional guidance for the Physician Compare website. Medicare patients and caregivers are able to use the Physician Compare website to search for and compare clinicians and groups who are enrolled in Medicare. The Physician Compare website also incentivizes clinicians to maximize their performance by making performance information publicly available.
Currently, Physician Compare is a website that allows users to search for clinicians and groups who are enrolled in Medicare. Some of the information on the site includes:
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Visit the Performance Information and Physician Compare page to learn more about the Quality Payment Program performance information and CMS quality program participation indicators reported on Physician Compare.
Consistent with the Affordable Care Act, CMS followed a phased approach to public reporting on Physician Compare. CMS began outlining a plan to do so in the 2012 Physician Fee Schedule (PFS) final rule. In this rule, CMS indicated that the first measures available for public reporting on Physician Compare would be the 2012 PQRS Group Practice Reporting Option (GPRO) measures collected via the GPRO Web Interface for groups of 25 or more eligible professionals. The 2012 Medicare Shared Savings Program final rule indicated the same for Accountable Care Organizations (ACOs).
On February 21, 2014, this first phase was successfully completed with the publication of the 2012 PQRS GPRO Diabetes Mellitus (DM) and Coronary Artery Disease (CAD) measures for the group practices and ACOs that successfully reported. In December 2014, CMS continued its plan to phase in quality reporting on Physician Compare by publicly reporting the second set of measure data for 139 group practices, 214 Shared Savings Program ACOs and 23 Pioneer ACOs, reflecting data collected via the Web Interface in 2013. For more information about these measures, please view the Performance Information and Physician Compare page.
The 2014 and 2015 PFS final rules further expanded on the public reporting plan to also include measures collected via the Web Interface, registry, and EHR; PQRS individual measures collected through an EHR, registry, or claims; and patient experience of care measures, specifically the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS and ACOs.
Performance information submitted through Qualified Clinical Data Registries (QCDRs) was publicly reported in late 2016 for the first time. Additionally, a subset of 2016 group PQRS measures were reported as star ratings for the first time in 2016.
This year, Quality Payment Program performance information (PDF) is currently on the website. For more information, check out the Quality Payment Program and Physician Compare Fact Sheet: What you need to know for Performance Year 2017 (PDF).
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). 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 information 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 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 information 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 (/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 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.).
Excerpt from CY 2019 PFS Final Rule
This section contains our approach for public reporting on Physician Compare for year 3 of the Quality Payment Program (2019 data available for public reporting in late 2020) and future years, including MIPS, APMs, and other information as required by the MACRA and building on our previously finalized public reporting policies (see 82 FR 53819 through 53832). Physician Compare (http://www.medicare.gov/physiciancompare) draws its operating authority from section 10331(a)(1) of the Affordable Care Act. Consistent with section 10331(a)(2) of the Affordable Care Act, Physician Compare initiated a phased approach to publicly reporting performance scores that provide comparable information on quality and patient experience measures. A complete history of public reporting on Physician Compare is detailed in the CY 2016 PFS final rule (80 FR 71117 through 71122). More information about Physician Compare, including the history of public reporting and regular updates about what information is currently available, can also be accessed on the Physician Compare Initiative website at /medicare/quality-initiatives-patientassessment-instruments/physiciancompare-initiative/.
As discussed in the CY 2018 Quality Payment Program final rule (82 FR 53820), Physician Compare has continued to pursue a phased approach to public reporting under the MACRA in accordance with section 1848(q)(9) of the Act. Generally, all data available for public reporting on Physician Compare must meet our established public reporting standards under § 414.1395(b). In addition, for each program year, CMS provides a 30-day preview period for any clinician or group with Quality Payment Program data before the data are publicly reported on Physician Compare under § 414.1395(d). All data available for public reporting—measure rates, scores, and attestations, objectives, etc.—are available for review and correction during the targeted review process. See the CY 2018 Quality Payment Program final rule for details on this process (82 FR 53820).
Lastly, section 104(e) of the MACRA requires the Secretary to make publicly available, on an annual basis, in an easily understandable format, information for physicians and, as appropriate, other eligible clinicians related to items and services furnished to Medicare beneficiaries under Title XVIII of the Act. In accordance with section 104(e) of the MACRA, we finalized a policy in the CY 2016 PFS final rule (80 FR 71131) to add utilization data to the Physician Compare downloadable database. We believe section 10331 of the Affordable Care Act supports the overarching goals of the MACRA by providing the public with performance 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, section 1848(q)(9) of the Act, and section 104(e) of the MACRA, we plan to continue to publicly report performance information on Physician Compare.
For Physician Compare questions, suggestions, or other feedback, contact the Physician Compare support team at PhysicianCompare-Helpdesk@AcumenLLC.com.
E-mail feedback and questions to the Physician Compare team at PhysicianCompare-Helpdesk@AcumenLLC.com.