What Does Medicare’s Physician Compare Website Say about Anesthesiologists, CRNAs and AAs?
Have you checked how your information appears on Medicare’s Physician Compare website? Is it accurate?
What Is Posted on Physician Compare—From Physician Demographics to Quality Measures
Mandated by the Patient Protection and Affordable Care Act, launched in 2010 and redesigned in 2013, the Physician Compare website is intended to serve a two-fold purpose:
- To provide information for consumers to encourage informed healthcare decisions; and
- To create explicit incentives for physicians to maximize performance.
(http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/physician-compare-initiative/Physician-Compare-Overview.html.) The website provides the public with the following information for all physicians, nurse anesthetists, anesthesiologist assistants and certain other healthcare professionals:
- Names, gender, addresses, and phone numbers;
- Physicians’ primary and secondary specialties;
- Group practice affiliations;
- Medical and clinical training information;
- Written/spoken languages other than English;
- Hospital affiliations, which link to the hospitals’ profile on Hospital Compare “when possible;”
- American Board of Medical Specialties (ABMS) board certification information;
- Whether physicians and other healthcare professionals accept Medicare Assignment;
- 2012 participation status in –
- Physician Quality Reporting System (PQRS);
- Electronic Prescribing (eRx) Incentive Program; and
- Electronic Health Record (EHR) Incentive Program
The volume and variety of data posted on the Physician Compare site is set to continue growing. Beginning this year, CMS is required to report physicians’ and others’ performance on quality measures. The Agency will implement a phased approach, placing the first set of measure data on the site in calendar year 2014, based on data collected no earlier than 2012. These data will include Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO) measures for group practices and Accountable Care Organizations (ACOs). On January 21, CMS announced a set of five quality measures related to diabetes, tobacco use and heart disease that will be reported for 141 Accountable Care Organizations (ACOs) and 66 group practices participating in the PQRS Group Practice Reporting Option. The information will give consumers comparative information: provider ratings are displayed using stars, which are a graphical representation of performance on a measure, and the actual percentage score is also listed to the right of the star display.
The plan for Physician Compare includes reporting patient experience data, notably the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) measures, for ACOs and group practices of 100 or more eligible professionals participating in the 2013 PQRS GPRO “as soon as technically feasible, but not before calendar year 2014.”
As for individual physicians and other healthcare professionals, CMS announced, when it published the Final Rule on the Physician Fee Schedule for 2014, that it would post data on 2014 PQRS individual measures collected through an EHR, registry or claims beginning in 2015. There are 20 measures that may lend themselves to such reporting, all of which align with measures reported by group practices through the GPRO web interface. CMS will determine the specific measures after data submission and review.
Utilization and Payment Data
Bipartisan legislation that would repeal the Sustainable Growth Rate (SGR) and establish a new methodology for updating the Medicare Fee Schedule (H.R. 4015, The SGR Repeal and Medicare Provider Payment Modernization Act of 2014) is pending in the House of Representatives. (We will provide detailed information on H.R. 4015 when and if it gets closer to passage – Ed.) This bill would require the Secretary would be required to publish utilization and payment data for physicians on the Physician Compare website by July 1, 2015.
Accuracy of the Website
In its letter to CMS Administrator Marilyn Tavenner dated September 6, 2013 “commenting” on the proposals that were finalized as part of the 2014 Physician Fee Schedule Rule, ASA stated that members had “expressed concern that their publicly available information is either incomplete or incorrect.” The letter cited one ASA leader who was listed as being affiliated with a hospital where he had never worked or been privileged.
At a “town hall” meeting held at Baltimore headquarters on February 24, 2014, CMS was told that a task force for another national medical association had found errors in 50 percent of their members’ profiles. Other physician representatives pointed to faulty demographic data and incorrect information about participation in PQRS.
Some of our clients have found that certain providers continue to be listed as affiliated with their groups many months after leaving.
The errors on the Physician Compare website have caught the attention of the Health and Human Services Office of the Inspector General (OIG), who included a review of the accuracy of the website in their Work Plan for 2014. The OIG noted that “CMS repurposed its Provider Enrollment, Chain, and Ownership System (PECOS) as its data source for provider information on Physician Compare. However, prior OIG work found that the provider information in PECOS was often inaccurate and, at times, incomplete.”
Anesthesiologists, CRNAs or AAs whose information on the website is inaccurate can correct it by following CMS’ instructions on amending PECOS records. The instructions state that editing or amending an existing record will take 15-20 minutes. Seeing the change made on Physician Compare may take a good deal longer, however. At the town hall meeting, CMS told participants that they could expect to wait for up to four months for corrections to appear.
Given the number of inaccuracies reported, and given the imminent posting of quality data, it is not surprising that medical associations like ASA have urged CMS to extend the preview period that will allow physicians and other professionals to view their data as it will appear on the web site in advance of publication beyond the current 30 days. In its September 2013 comment letter, ASA urged CMS to extend the review period to allow 90 days for a physician to review and appeal his or her information. CMS has suggested shortening the period, however, to two weeks.
Whether the Physician Compare website will provide accurate and meaningful information for patients researching providers is very much an open question. More and more data are going to appear on the website, regardless, and physicians and other healthcare professionals will want to check their information periodically.