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Quality Data and Physician Compare

This section provides more information about quality measures data and the public reporting plan for Physician Compare. To learn more about Physician Compare’s Statutory Authority, visit the section About Physician Compare: An Overview. Select the question below to view the corresponding answer.

You are welcome to send feedback and questions to the Physician Compare team at PhysicianCompare@Westat.com.

General Quality Data Information

How did CMS decide what measures to post on Physician Compare?
Will all individual and group practice measures designated as “available for public reporting” be included on Physician Compare?
How are measures determined to be “suitable for public reporting”?
How are measures displayed on Physician Compare?
If an individual health care professional participates under a GPRO, will the individual professional have measure data on his/her profile page?
How are measures calculated?
Can users compare individual health care professionals or group practices on Physician Compare?

Quality Measures Data in 2015 and Beyond

What quality measures are currently on Physician Compare?
What quality program information is currently available on Physician Compare?
What group practice measures are available for public reporting in late 2015?
When will individual measures be publicly reported on Physician Compare?
Will CAHPS measures for individual health care professionals be publicly reported on Physician Compare?
Are ACO quality data available on Physician Compare?
What measures are available for public reporting in 2016?

30-Day Preview Period

How do individual health care professionals and group practices preview their measure data before it is posted on Physician Compare?
How do ACOs preview their measure data before it is posted on Physician Compare?
Will there be an appeals process?

General Quality Data Information

How did CMS decide what measures to post on Physician Compare? 

All measures available for public reporting on Physician Compare are decided via rulemaking. If a measure is designated as “available for public reporting” in the rule, then it may be publicly reported on Physician Compare. The specific measures included on the website are chosen based on their reliability, validity, accuracy, and consumer relevance. A Technical Expert Panel (TEP) is consulted, as well as CMS measure experts, and consumer testing is also conducted.

Will all individual and group practice measures designated as “available for public reporting” be included on Physician Compare? 

If a group practice or individual health care professional reports any of the measures designated as “available for public reporting” in the Physician Fee Schedule rule, then the measure may be included on the Physician Compare website. Only those measures deemed statistically comparable, valid and reliable and that meet public reporting standards, including the minimum 20-patient threshold, will be considered for inclusion on the website. If the minimum threshold is not met for a particular measure, or the measure is otherwise deemed not to be suitable for public reporting, the group or individual’s performance rate on that measure will not be publicly reported.

We continue to work to ensure that measures are labeled accurately and accompanied by explanations that are both true to the measure specifications and accurately understood by health care consumers, while adhering to HHS plain language guidelines. In the interest of transparency, all measures found to be statistically valid and reliable will be made available to all via a downloadable database on data.medicare.gov, even if they are not all listed on the Physician Compare profile pages.

How are measures determined to be “suitable for public reporting”? 

The Physician Compare support team conducts consumer testing to evaluate the best measures to include on the public-facing profile pages. This testing includes

  • Having consumers evaluate the plain language measure descriptions to ensure that they are accurately interpreted; and
  • discussing with consumers how and if the measures they are evaluating would help them make a decision about choosing a health care professional or group practice.

CMS keeps open lines of communication with stakeholders to ensure that measures considered for public reporting are clinically relevant and consistent with current practice standards. In addition, measures must meet the public reporting requirements set out in rulemaking, as noted in the question above.

How are measures displayed on Physician Compare? 

Each measure title is on its own expand/collapse bar with an associated graphical representation of the percent in a series of five stars and the actual percent listed to the right. All the measures will be collapsed when a user first sees the page. A user can then expand each measure to see additional information.

At this time, the stars are simply graphical representations of the percent. Each star represents 20% and so 100% is 5 stars, 80% is 4 stars, etc.

We anticipate that measures will display similarly for 2014 data as they are currently displayed for 2013 data. CAHPS for PQRS, which are patient experience measures, will be added. These will have the summary survey scores displayed, and we anticipate this will be shown as both stars indicating a graphical representation of the percent and the percent performance score. The details of the measure display will be finalized after additional consumer testing is completed.

If an individual health care professional participates under a GPRO, will the individual professional have measure data on his/her profile page? 

Group level measures are only displayed on the group practice profile page. Individual EP data will only be displayed at the individual level. If an individual EP is affiliated with a group practice that has measure data, there is a check mark on the individual’s profile that indicates PQRS participation but no group-level measure data.

How are measures calculated? 

For specific details on how measures are calculated, you can consult the PQRS specifications or contact the QualityNet Help Desk with questions.

Can users compare individual health care professionals or group practices on Physician Compare? 

Users can compare group practices on Physician Compare. You can select up to three group practices to compare side by side. This feature is only available for group practices at this time. CMS is considering options for including the same functionality for individual health care professionals.

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Quality Measures Data in 2015 and Beyond

What quality measures are currently on Physician Compare? 

In December 2014, the 2013 PQRS GPRO Diabetes and CAD measures collected via the Web Interface were posted on Physician Compare for 139 group practices and 214 Shared Savings Program and 23 Pioneer ACOs.

CAHPS for ACO survey measures were also added. This is the first set of patient experience of care measures to be included on Physician Compare.

What quality program information is currently available on Physician Compare? 

Physician Compare includes information about physicians and other health care professionals who satisfactorily participate in CMS quality programs. Currently, Physician Compare publicly reports the 2013 data for the following programs.

Individual EPs have a green check mark on their profile page if they:

  • Satisfactorily report under the Physician Quality Reporting System (PQRS);
  • Successfully participate in the Electronic Prescribing (eRx) Incentive program;
  • Participate in the Electronic Health Record (EHR) Incentive program; or
  • Report as part of the 2013 PQRS Cardiovascular Prevention measures group in support of Million Hearts®.

Group Practices have a green check mark on their profile page if they:

  • Satisfactorily report under the Group Practice Reporting Option (GPRO); or
  • Successfully participate in the Electronic Prescribing (eRx) Incentive program.

What group practice measures will be publicly reported in late 2015? 

The following group-level measures will be publicly reported on Physician Compare in late 2015:

  • A sub-set of the 2014 PQRS GPRO measures collected via the Web Interface for group practices of 25 or more EPs.
  • A sub-set of the 2014 Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS measures.
    • Required for group practices of 100 or more EPs.
    • Optional for group practices of 25-99 EPs reporting via a certified CAHPS vendor.

For a list of the specific measures, refer to the 2014 Group Measure Table. This was finalized in the 2014 PFS final rule.

When will individual measures be publicly reported on Physician Compare? 

The following individual data will be available for public reporting on Physician Compare in late 2015:

  • A sub-set of 2014 PQRS individual EP measures collected via claims.
  • Individual EP measures from the 2014 PQRS Cardiovascular Prevention measures group in support of Million Hearts.

For a list of the specific measures, refer to the 2014 Individual EP Table. This was finalized in the 2014 PFS final rule.

Will CAHPS measures for individual health care professionals be publicly reported on Physician Compare? 

CAHPS measures for individual health care professionals are not under consideration for public reporting on Physician Compare at this time as such data are currently not being collected.

Are ACO quality data available on Physician Compare? 

Users can access these data from the Physician Compare home page by clicking on the “Accountable Care Organization (ACO) Quality Data” link in the Additional Information section. This will take you to a section of the website dedicated solely to Shared Savings Program and Pioneer ACO public reporting. At the top of the page there is general information about the ACO program and the 2014 quality data available. Users can search for an ACO in two ways. The first tab allows users to search for an ACO by name or browse through all ACOs with the “Search A-Z Index” option.

Currently, 2013 measures that mirror the measures reported for group practices and CAHPS for ACO measures are available on Physician Compare.

What measures are available for public reporting in 2016? 

You can learn more about public reporting in the Physician Compare sections of the 2015 Physician Fee Schedule (PFS) final rule or by viewing the public reporting plan documents in the Downloads box below.

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30 Day Preview Period

How do individual health care professionals and group practices preview their measure data before it is posted on Physician Compare? 

All group practices and individual health care professionals with measure data will have a 30-day preview period prior to publication of their data. This allows groups and individuals to see their data as it will appear on Physician Compare before it is reported.

The specifications of each 30-day preview period may vary every year. However, everyone can expect to be contacted directly by the Physician Compare support team prior to the start of the preview period. The contact information for each group practice and individual health care professional comes from the information provided at the time of PQRS registration. Therefore, it is important that everyone keep an eye out for information that preview has started. The preview period will also be announced via the Physician Compare listserv and other CMS outreach avenues such as the MLN Provider eNews.

If you have any questions about measure preview or public reporting generally, you can always direct those questions to the Physician Compare team.

How do ACOs preview their measure data before it is posted on Physician Compare? 

ACOs will be able to view their quality data that will be publicly reported on Physician Compare through the ACO Quality Reports. These will be made available to ACOs for review at least 30 days prior to the start of public reporting on Physician Compare. The quality reports will indicate the measures that are available for public reporting. ACO measures will be publicly reported in plain language, so a crosswalk linking the technical language included in the Quality Report and the plain language that will be publicly reported will be provided to ACOs at least 30 days prior to the start of public reporting.

Will there be an appeals process? 

No, there will not be a formal appeals process. If measure data is collected and deemed suitable for pubic reporting, the data will be published on Physician Compare. All data will be published regardless of whether measure preview was confirmed.  

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