Understanding the Medicare Physician Compare Website

The Affordable Care Act (ACA) required the Centers for Medicare and Medicaid Services (CMS) to develop a Physician Compare website by January 1, 2011. In order to comply with the law, CMS launched the Medicare Physician Compare website in late December.

Design of Physician Compare Website

Prior to launch of the new website, CMS published a Healthcare Provider Directory on Medicare.gov. This site allowed individuals to search for a physician or other healthcare professional by specialty or type of professional and location, along with education, hospital affiliation, and other information. CMS relabeled the Health Care Provider Directory as the Physician Compare website.

Demographic data populated in the Physician Compare website, such as practice phone numbers and addresses, Medicare participation status and education information, are based on data found in the internet-based Provider Enrollment, Chain, and Ownership System (PECOS). Therefore, it is imperative that physicians and other healthcare professionals keep their Medicare enrollment information up to date. Physicians are required to report any changes to their enrollment status within 30 days. A current enrollment record must be in PECOS and must contain the physician's National Provider Identifier (NPI). Visit CMS's website to update your enrollment record. CMS has compiled some Medicare enrollment tips to help you through this process.

The original Healthcare Provider Directory also included the names of eligible professionals who participated in the 2008 Physician Quality Reporting System (PQRS), formerly known as PQRI. To comply with the ACA, CMS is now using the Physician Compare website to post the names of eligible professionals or group practices who satisfactorily submitted data on quality measures for the PQRS, as well as the names of those who are successful electronic prescribers. When one clicks on a physician's name in the directory, information about whether he or she successfully participated in the PQRS will be listed along with the address and other information.

Measures Selection

The ACA requires CMS to implement a plan for making physician performance information available on the Physician Compare website by January 1, 2013. The reporting periods will not begin before January 1, 2012. In the meantime, CMS will continue to solicit feedback regarding the selection of physician performance measures for public reporting. These measures are required, to the extent practicable, to include the following:

• Measures collected under the PQRS
• An assessment of patient health outcomes and functional status
• An assessment of the continuity and coordination of care and care transitions

In developing Physician Compare, the ACA requires CMS to consider making statistically valid and reliable data public, using risk adjustment methodology, along with physician review of data; accurate portrayal of physician performance; data that reflects the care provided to all patients, not just Medicare; attribution of care; timely physician performance feedback; and implementation of a computer and data system to support valid public reporting activities.

These issues and others will be considered by CMS as it determines the level of data reporting, processes of data collection, and details surrounding data preview for physicians.

AMA Advocacy

AMA has been engaged in a dialogue with CMS regarding Physician Compare. Not only did AMA participate in a CMS townhall meeting last October to discuss the design and format of a Physician Compare website, but the association also submitted a statement to CMS regarding its efforts to establish the website. The statement urges CMS to be judicious in its development, specifically balancing current methodological limitations associated with physician profiling with the ACA's statutory directives.

As a result of AMA advocacy, CMS now recognizes problems with the PECOS system, and AMA continues to work hard to secure improvements. CMS is undertaking a review of PECOS with the intent to revamp the system. AMA also has learned that updated data in the PECOS system does not immediately get transferred to the Physician Compare website. AMA has brought this problem to CMS's attention and is working to get this fixed. Since the PECOS information serves as a basis for the Physician Compare site, AMA will continue its aggressive efforts to ensure the accuracy and ease of use of the PECOS system.

In addition, AMA will continue to provide feedback to CMS regarding the design of the Physician Compare website. Public reporting of performance information — if not approached thoughtfully — can have unintentional adverse consequences for patients and for physician practices. AMA will continue to work on several critical issues that must be resolved before public reporting provisions can be implemented.

These include methods for ensuring that any publicly reported information is:

• Correctly attributed to those involved in care
• Appropriately risk-adjusted
• Accurate, user-friendly, relevant and helpful to the patient

Physicians and other providers involved in the treatment of a patient must also have the opportunity for prior review and comment as well as the right to appeal any data that is part of the public review process. Such comments also should be included with any publicly reported data.

Visit the AMA website for more information on AMA advocacy efforts regarding the implementation of the Physician Compare website or other ACA provisions.