Overview of the Physician Compare Initiative
Introduction to the Initiative
Launched as part of the Affordable Care Act (ACA) in 2010, the Physician Compare initiative began as an online database aimed at helping patients find Medicare-eligible healthcare professionals. Since its inception in 2011, the Physician Compare website has been consistently updated by the CMS Medicare department to provide valuable information that empowers patients to make informed healthcare choices.
Purpose and Functionality
The Physician Compare portal serves to enhance transparency in healthcare, a challenge amidst the involvement of numerous stakeholders. This platform not only highlights clinicians’ performance under the Merit-based Incentive Payment System (MIPS) but also promotes engagement among patients, CMS, and providers. Through this portal, healthcare consumers can evaluate physicians based on their scores in key MIPS categories: Quality, Promoting Interoperability (PI), and Improvement Activities. This initiative represents a significant step towards recognizing CMS’s commitment to improving healthcare quality.
Incentives for Clinicians
Improving Performance
The Physician Compare Initiative also aims to motivate clinicians and healthcare groups to enhance their performance. The MIPS 2017 performance data available on the portal aligns with this objective. Patients can choose Medicare physicians with higher ratings, while clinicians may receive payment adjustments based on their performance metrics. Various measures, including MIPS quality measures, Consumer Assessment for Healthcare Providers and Systems (CAHPS), and Qualified Clinical Data Registry (QCDR), are utilized to generate scores and ratings for both individual providers and clinician groups.
Upcoming Changes for MIPS 2020
As MIPS evolves, CMS is preparing for the MIPS 2020 program, ensuring continuous improvement and adaptation to the changing healthcare landscape.
Current Features of the Physician Compare Website
Available Information
The Physician Compare website currently offers essential information about physicians and group practices, including names, practice locations, contact numbers, specialties, gender, medical certifications, affiliations, and spoken languages. However, it primarily serves as an informational resource, indicating whether a physician participated in the now-retired Physician Quality Reporting System (PQRS). The latest updates reflect data related to MIPS 2017.
Supporting Healthcare Initiatives
The portal also identifies doctors who are part of the Million Hearts initiative, which is overseen by the Department of Health and Human Services (HHS), reinforcing the commitment to improving healthcare quality and reducing costs.
Implications for Physicians
Reputation and Performance
The Physician Compare Initiative underscores the importance of clinician reputation, as MIPS scores now transcend mere financial incentives. Physicians who previously reported minimal data to avoid MIPS penalties must reevaluate their strategies. A clinician’s MIPS score can significantly influence their professional opportunities, recruitment prospects, potential mergers or acquisitions, and contracts with insurance providers.
Eligibility Criteria
To be featured on the website, a physician or provider group must have verified Medicare PECOS information and must have submitted at least one value-based claim within the past 12 months. Additionally, groups should consist of at least two clinicians reallocating their benefits collectively.
Data Sources and Quality Measures
Updating the Website
CMS employs various data sources to maintain and enhance the website, with plans for future expansion. The information presented may come from self-reported data through claims, qualified clinical data registries, CAHPS, and the PECOS. Furthermore, CMS collaborates with national certifying boards to verify board certifications and determine the reliability of quality measures displayed on the website.
Star Ratings System
Beginning this year, performance on quality measures will be represented using a one-to-five star rating system, where each star correlates to a 20 percent performance score on MIPS. This relative rating system enables easy comparison among eligible practitioners and groups.
Information Review and Correction
30-Day Preview Period
CMS will provide a 30-day preview period for clinicians to review and correct their information before it is published on the Physician Compare website. Notifications will be sent through the MLN Connects weekly newsletter and other platforms. Clinicians who identify inaccuracies may contact CMS for corrections, though proof may be required. It is crucial to act during this preview period, as there is no formal appeals process.
Updating Provider Information
If clinicians change practices or upgrade certifications, they must update their information via PECOS, understanding that corrections may take up to four months to reflect on the website. This lag can delay improvement efforts based on past performance.
Conclusion and Support for Clinicians
P3 Healthcare Solutions serves as a MIPS Registry for the second consecutive year in 2018, offering advanced analytical tools to help clinicians monitor their performance year-round and estimate their MIPS scores. It is essential for healthcare providers to seek expert advice on balancing the costs associated with achieving a high MIPS score against the potential negative impacts of a low score. For more information or assistance, contact one of our MIPS medical billing service experts at 1-844-557-3227 or via email at [email protected].