About Physician Compare: An Overview
This page provides an overview of the purpose, evolution, and future of PhysicianCompare.
For Physician Compare questions, suggestions, or other feedback, contact the Physician Compare Support Team at PhysicianCompare@Westat.com.
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?
What is Physician Compare’s Statutory Authority?
The Centers for Medicare and Medicaid Services (CMS) created the Physician Compare website as required by the Patient Protection and Affordable Care Act (ACA) of 2010. The site was launched on December 30, 2010. Initially, Physician Compare used the existing Healthcare Provider Directory on Medicare.gov. Since that time, CMS has continually worked to make the site function better, improve the information available, and provide useful information about physicians and other health care professionals who take part in Medicare. This ongoing effort, along with the addition of quality measures on the site, helps Physician Compare serve its two-fold purpose:
- Provide information to help consumers make informed decisions about their health care
- Create clear incentives for physicians to perform well
Currently, Physician Compare is a website that allows consumers to search for physicians and other health care professionals who provide Medicare services. Some of the information on the site includes:
General Information - Physicians and other Health Care Professionals
- Names, addresses, and phone numbers
- Primary and secondary specialties
- Group practice affiliation
- Clinical training information
- Hospital affiliation, which links to the hospital’s profile on Hospital Compare, when possible
- American Board of Medical Specialties (ABMS) Board Certification information
- Medicare Assignment (that is, whether the patient will be billed for any more than the Medicare deductible and coinsurance)
- Spoken languages, in addition to English
General Information – Group Practices
- Addresses, phone numbers, maps, and directions
- List of physicians and other health care professionals within the practice
Quality Program Participation Indicators
Physician Compare includes information about physicians and other health care professionals who satisfactorily participate in CMS quality programs. More information about each quality program is available by selecting on the links below.
- An indicator of group practices’ and individual health satisfactory participation in the 2014:
- An indicator of group practices’ satisfactory participation in the 2014:
- Physician Quality Reporting System (PQRS) Incentive Program
- Electronic Health Records (EHR) Incentive Program
- Maintenance of Certification (MOC) Program Incentive
- An indicator of individual eligible professionals that successfully reported the 2014 PQRS Cardiovascular Prevention measures group in support of Million Hearts
Physician Compare is phasing in quality measures over the next several years. Quality measures are tools that help measure health care processes and outcomes. These data are associated with the ability to provide high-quality health care. The following quality measures are publicly reported on Physician Compare:
- 2013 PQRS GPRO and Accountable Care Organizations (ACO) GPRO Diabetes Mellitus (DM) and Coronary Artery Disease (CAD) measures.
CMS uses public and stakeholder feedback from Town Hall meetings, Listening Sessions and e-mail received at PhysicianCompare@Westat.com. The annual rulemaking process defines the scope and direction of Physician Compare. CMS proposes new policies through the annual rulemaking process, which includes the timeline and type of information that will be publicly reported on Physician Compare, providing the public and stakeholders an opportunity to comment on these proposals and give CMS their opinion.
Consistent with the Affordable Care Act, CMS will phase in quality measures on Physician Compare over the next several years. 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 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 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 Quality Data and Physician Compare page.
The 2014 and 2015 PFS final rules further expand on the public reporting plan by finalizing the inclusion of PQRS GPRO and ACO GPRO 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 for ACOs measures.
For more detailed information about these data, please view the Public Reporting Plan Outline and the Public Reporting Timeline documents on the Informational Materials page.
Physician Compare includes information about physicians and other health care professionals who satisfactorily participate in the following CMS quality programs:
Physician Quality Reporting System (PQRS)
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 Electronic Prescribing (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 health care professionals to report information about the quality of the care they provide to people with Medicare who have certain medical conditions. Physicians and other health care professionals can choose whether to report quality information through PQRS. Profile pages on Physician Compare show whether physicians and other health care professionals have taken part in PQRS.
Electronic Prescribing (eRx) Incentive Program
The Electronic Prescribing (eRx) Incentive Program is a pay-for-reporting program that encourages physicians and other health care professionals to use electronic prescribing to improve communication, increase accuracy, and reduce errors. To participate in this Medicare program, physicians and other health care professionals must report on their use of a qualified eRx system. Profile pages on Physician Compare show if physicians and other health care professionals are participating in the eRx Incentive Program.
Electronic Health Record (EHR) 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 health care. Profile pages on Physician Compare show if physicians and other health care professionals are participating in the EHR Incentive Program.
Maintenance of Certification (MOC) Program Incentive
The PQRS Maintenance of Certification (MOC) Program Incentive gives an additional incentive to physicians who satisfactorily report PQRS measures and more frequently than is required participate in a Maintenance of Certification Program and successfully complete a Maintenance of Certification Program practice assessment. Profile pages on Physician Compare show if physicians and other health care professionals are participating in the MOC Program Incentive.
Million Hearts® is a national initiative that focuses action by communities, health systems, nonprofit organizations, federal agencies, and private-sector partners to prevent a million heart attacks and strokes by 2017. Million Hearts encourages physicians and other healthcare professionals to report—and excel in-- the Cardiovascular Prevention measures group in the PQRS program. High performance in these measures dramatically reduces the likelihood of a heart attack or stroke. Profile pages on Physician Compare show if physicians and other health care professionals are participating in Million Hearts.
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). 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: 04/21/2016 2:19 PM
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