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From Health Law Daily, December 11, 2015

CMS website lets you give your physician a check-up

By Jenny Burke, J.D., M.S.

Individuals may now have access through the CMS website to clinical quality performance data on their personal physician. Gathered from 2014 clinical quality performance measures for approximately 40,000 individual physicians who reported the information via Medicare's Physician Quality Reporting System, the data is available in part for the very first time, available on “Physician Compare.” Doctors submitted the data voluntarily, although beginning in 2016 they will face a penalty if they opt out. New quality data is also available for hospitals on the Hospital Compare website.

Information available includes the following:

  • Performance scores on preventive care, diabetes, cardiovascular care, and patient safety by some group practices. Approximately 275 group practices who reported information as part of Medicare’s quality reporting program, the Physician Quality Reporting System (PQRS) are included. The measures show how well a group practice provides certain types of care to people with Medicare.
  • New performance scores on patients’ experiences with some group practices. CMS posted measures for approximately 290 group practices who reported patient experience measures through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS survey. The CAHPS for PQRS survey asks Medicare patients for feedback regarding their experiences getting care from their group practice.
  • First set of individual health care professional performance scores on preventive care, cardiovascular care, and patient safety measures. CMS posted 2014 clinical quality of care measures for over 40,000 individual health care professionals who reported as part of PQRS.
  • Updated performance scores for ACOs. CMS posted the 2014 clinical quality of care and patient experience measures for approximately 333 Shared Savings Program ACOs and 20 Pioneer ACOs.

The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) required CMS to create the Physician Compare website. The goal of the website is to help consumers make informed choices about their health care. The first quality measures were added to Physician Compare in February 2014. Since then, the number of individuals, groups, and organizations reporting quality data has continued to increase.

Hospital Compare. CMS also posted new 2014 data to its Hospital Compare site, including those for hospital surgical practices and certain health care-associated infections. Adult and pediatric medical, surgical, as well as combined medical and surgical wards have been added.

CMS plans to add additional measures in the future, which may include data collected from EHR systems and qualified registries. CMS noted that the criteria for public reporting require that the measures must be statistically valid and reliable, accurate, and comparable; have a minimum sample size of 20 patients; and resonate with consumers.

AMA response. Despite its reminder about its data accuracy requirements, the American Medical Association (AMA) is “disappointed” with the publicly posted information on Physician Compare. It believes that CMS has posted incomplete and potentially inaccurate information to the online resource that will only serve to misinform patients.

"Given the widespread accuracy issues with the 2014 PQRS calculations, the newly released information is premature, said Steven J. Stack, M.D., the President of the AMA, in a release. “The data inaccuracies and difficulties with CMS' processes grew over the last couple of months and, while CMS has acknowledged these problems, it has failed to address the underlying issues. Most importantly, consumers visiting the Physician Compare website are likely to get a false impression that it provides accurate quality information for all physicians, when in fact, due to significant data problems, the newly added information covers only about 40,000 physicians.”

MainStory: TopStory AgencyNews CMSNews QualityNews

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