The Healthmonix Advisor

What You Need To Know About Physician Compare

Posted by Lauren Patrick on July 7, 2017
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Transparency is a vital aspect of the transition to quality care because it allows patients to make more informed healthcare choices. To this end, CMS has increased accessibility of physician information with the Physician Compare website, which publicly reports provider data including some quality measures. If you are a provider and want to assess or even optimize how you appear compared to your peers, you may have questions about how the Physician Compare website works and how to make sure it represents you accurately.

What qualifies me to appear on Physician Compare?

To be included on the website, you must be a physician, other clinician, or part of a provider group with current and “approved” Medicare Provider Enrollment, Chain, and Ownership System (PECOS) information. You must also have a valid physical address for your practice, as well as a National Provider Identifier (NPI). Clinicians are required to have submitted at least one Medicare Fee-for-Service claim within the last 12 months. Groups must have at least two approved clinicians reassigning their benefits to the group.

What information appears on the site, and where does CMS get this information from?

Your basic information including name; address; phone number; primary and secondary specialties; school and year of graduation; and hospital affiliations is taken from PECOS, so maintaining accurate and updated information in this system is important if you want patients to be able to find you. Physicians who support the U.S. Department of Health and Human Services Million Hearts initiative are also identified. Performance on particular quality measures is shown as well, and is represented with a star rating system that corresponds directly to the percentage of your performance score for that measure.
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How does CMS decide which measures to post?

This is decided based on Physician Fee Schedule rulemaking. If a measure is designated as “available for public reporting” in the rule, then it may be publicly reported on Physician Compare. CMS explains that it chooses measures based on reliability, validity, accuracy, and consumer relevance. A Technical Expert Panel (TEP) and CMS measure experts are consulted, and consumer testing is also conducted. Information from the Value-Based Payment Modifier (VM) program, as well as all measures reported by the Medicare Shared Savings Program and utilization data generated from Medicare Part B claims, will be included. All measures found to be statistically valid and reliable will be made available via a downloadable database on data.medicare.gov, even if they are not all listed on the Physician Compare profile pages.

Can I check my information before it goes live?

CMS provides a 30 day preview period before measures are posted on Physician Compare, and directly contacts physicians using the information provided at the time of PQRS registration. CMS also announces this preview period via the Physician Compare listserv, the MLN Provider eNews, and other sources of outreach. Physicians may also preview their VM tier with Quality and Resource Use Reports (QRURs), which can be accessed on the CMS website. Additionally, ACOs will be able to review quality reports at least 30 days before their data is publicly reported.

How can I fix any incorrect information?

You can report any errors in your information to PhysicianCompare@Westat.com. There is no appeals process, so be sure to identify any issues during the preview period. CMS also has a helpful FAQ page about how to update or add information to the website. Edits made in PECOS can take two to four months to be reflected on Physician Compare.

Topics: MACRA and MIPS, PQRS, MACRA, CMS, Physician Compare