Introduction To The Physician Compare Initiative

Launched as a part of the Affordable Care Act (ACA) or the Obamacare Act of 2010, the physician compare initiative started out as a simple online searchable database of healthcare professionals eligible under Medicare.  Since its launch in 2011, the Physician Compare website has been regularly updated by the CMS Medicare department to enhance the information that helps patients make informed healthcare decisions.

Physician Compare Portal Is a Way to Translate CMS Vision

Maintaining healthcare transparency is getting difficult with many stakeholders getting involved. However, such a portal, which is necessary to showcase clinicians’ MIPS performance, also gives way to engaging patients, CMS, and clinicians alike.

Consider it as a platform where all healthcare consumers can review how physicians are doing in the respective MIPS categories, Quality, Promoting Interoperability (PI), and Improvement Activities.

Indeed it is a good step in recognizing CMS efforts to improve the quality of care.

The second purpose of the Physician Compare Initiative is to incentivize clinicians and clinician groups to improve their performance. MIPS 2017 performance information on the portal is in line with both purposes. Patients can select Medicare physicians with higher ratings while clinicians receive payment adjustments based on their performances.

MIPS quality measures, Consumer Assessment for Healthcare Provider and Systems (CAHPS), and Qualified Clinical Data Registry (QCDR) measure convert into scores and ratings for individuals and clinician groups. MIPS thrives in the present and before it enters into the year 2020, CMS has a proposal ready for the MIPS 2020 program.

Changes to Physician Compare Website

Presently, the Physician Compare website shows necessary physician and group association information like physician name, practice name, location, phone numbers, specialties, gender, medical certifications, affiliations, and languages spoken. However, so far the website is just that, it gives the necessary information. The website does say whether or not a physician participated in the outdated Physician Quality Reporting System (PQRS) program and the most recent information on the site is related to MIPS 2017. Doctors supporting the Million Hearts initiative by the Department of Health and Human Services (HHS) are also identified.

Portal for Patients and Clinicians

The physician compare initiative stands firm on grounds to improve the quality of care and reduce healthcare expenses. CMS has made it clear on numerous occasions that the Quality Payment Program is here to stay and works for the betterment of US healthcare. After 2017, we are going to have a MIPS 2018 showdown of scores and star ratings, and it is going to add a rich flavor to this program.

The portal displays provider scores in performance categories, i.e., Quality, Cost, Promoting Interoperability, and Improvement Activities. The data will be available in downloadable file format free for use by online directories and health information websites like Yelp, ZocDoc, Healthgrades, Vitals, etc.

Reputation Impact of Physicians. Compare

What this means is that all those clinicians that have been reporting a minimal amount of data to avoid a MIPS penalty need to rethink their strategy. MIPS score is not only about receiving an incentive payment anymore. The doctor’s reputation is at stake here, not just dollars. Furthermore, individual physician star ratings will follow them if they change their organization. The MIPS score may directly impact their future career opportunities, clinician recruitment, potential mergers or acquisitions, insurance contracts, and more.

Eligibility Criteria for Appearance on the Website

A physician or a provider group needs to have ratified Medicare PECOS information available. Furthermore, the clinicians should have submitted at least one value-based claim within the last 12 months. Groups must have at least two clinicians reallocating their benefits to the group as a whole.

What Sources of Data Will CMS Use?

CMS has been using multiple sources to update its website; these sources will be expanded in the future. The information displayed on the site may be derived from self-submitted data via claims, qualified clinical data registry, qualified registries, consumer assessment of healthcare providers and systems (CAHPS), and the provider enrollment, chain, and ownership system (PECOS). CMS also coordinates with national certifying boards to confirm board certifications. CMS determines which quality measures are statistically reliable enough to be displayed on the website.

Star Ratings for Easy Comparison

Beginning this year, performance on quality measures will be depicted by a one-to-five star rating system. Each star represents a 20 percent performance score on MIPS (i.e. 1 Star = 20%, 2 Stars = 40%, 3 Stars = 60%, 4 Stars = 80%, 5 Stars = 100%). These ratings are relative, that is, they depend on the performance of other eligible practitioners and groups under the program.

30-Day Preview for Checking Information & Correction

CMS has announced that it will provide a 30-day preview to the clinicians for review and correction before the measures and ratings are finally made public on the Physician Compare website. The physicians will be made aware through the MLN Connects weekly newsletter and various other platforms. If you discover any errors or omissions in the information, you can contact CMS for correction. You may need to submit proof supporting your claim for your correction. Also, there is no formal appeals process thus ensuring correction within the 30 days preview period is highly critical. If you discover any errors during the preview period, you can report them to CMS via the contact information provided on the website.

Be patient, for instance, if you have switched a group practice or a hospital, or you upgraded your certifications, you need to update the information through PECOS. Corrections made in PECOS could take up to 4 months to be reflected on the website. That means when they learn about bad performance, the year after the bad performance will also almost be over. Thus they can start focusing on improvement only in the next year.

P3 Healthcare Solutions is a MIPS Registry for the second consecutive year in 2018. Our advanced analytical tools help you track your performance throughout the year and can give an estimated MIPS score to ensure that you are satisfied with your score before you submit your reports to CMS.

It is very vital to get an expert opinion about how to balance the costs associated with getting a high MIPS score and the potential negative impacts of a low MIPS score.  For any more questions related to this, or for instructions on how to get started call one of our MIPS medical billing service experts today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@p3care.com.