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Physician CompareVirtual Office Hour SessionJanuary 22, 2015Alesia HovatterHealth Policy AnalystDivision of Electronic and Clinician QualityQuality Measurement and Health Assessment GroupCenter for Clinical Standards and QualityCenters for Medicare & Medicaid Services
DisclaimersThis presentation was current at the time it was published or uploaded onto the web. Medicare policychanges frequently so links to the source documents have been provided within the document for yourreference.This presentation was prepared as a tool to assist providers and is not intended to grant rights orimpose obligations. Although every reasonable effort has been made to assure the accuracy of theinformation within these pages, the ultimate responsibility for the correct submission of claims andresponse to any remittance advice lies with the provider of services. The Centers for Medicare &Medicaid Services (CMS) employees, agents, and staff make no representation, warranty, orguarantee that this compilation of Medicare information is error-free and will bear no responsibility orliability for the results or consequences of the use of this guide. This publication is a general summarythat explains certain aspects of the Medicare Program, but is not a legal document. The officialMedicare Program provisions are contained in the relevant laws, regulations, and rulings.CPT only copyright 2011 American Medical Association. All rights reserved. CPT is a registeredtrademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply toGovernment Use. Fee schedules, relative value units, conversion factors and/or related componentsare not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. TheAMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumesno liability for data contained or not contained herein.2
Welcome Purpose of the Session Overview of Agenda3
Overview of Physician CompareTwo- Fold PurposeEncourageconsumers tomakeinformedchoicesIncentivizephysicians tomaximizeperformance4
Overview of Physician CompareCMS repurposed the Medicare.gov HealthcareProvider Directory into Physician Compare Medicare Provider Enrollment, Chain, andOwnership System (PECOS) as the underlying datasource Ability to search by location and specialty Basic contact and demographic information5
Overview of Physician CompareImproved DatabaseIntelligent Search tabase6
Physician Compare DataInclusion criteria for Physician CompareIndividual Health Care Professionals(HCPs) must:Group Practices must: Be in approved status in PECOS Be an approved Medicare provider Provide at least one practice locationaddress Have a Legal Business Name Have a valid mailing addressHave at least one specialty noted inPECOS Have a Tax Identification Number (TIN) Have at least two health careprofessionals submit a Medicare claimunder the group’s TIN within the last 12months or be newly enrolled in PECOSwithin the last 6 months Have submitted a Medicare claim withinthe last 12 months or be newly enrolledin PECOS within the last 6 months7
Physician Compare DataPrimary information from PECOS and claimsFor Individual HCPs:For Group Practices: First and Last Name Legal Business Name and/or DoingBusiness As (DBA) name, if available Specialty Addresses/phone numbers Group practice affiliation Medicare Assignment status Gender Education Practice Locations Addresses/phone numbers Affiliated HCPs Specialties Medicare Assignment status8
Physician Compare DataPractice Locations Cross-reference PECOS and Medicare claims dataHospital Affiliation Self-reportInpatient hospital claimsOutpatient hospital claimsPhysician and ancillary service claims9
Physician Compare DataAmerican Board of Medical Specialties (ABMS)Board Certification and Residency Information Database compiled by Elsevier in cooperation withABMS Email abms.feedback@elsevier.com for questionsabout the board certification information on yourprofile pages10
Physician Compare DataMedicare Assignment Group practices and HCPs identify their status whenthey enroll in MedicareMedicare Assignment Icons “Accepts Medicare Assignment” “May Accept Medicare Assignment”Icon display on Physician Compare Depends on group practice and/or individual HCP’sPECOS enrollment11
Physician Compare DataDownloadable Database General information and Medicare qualityprogram participation for individual HCPs 2013 Physician Quality Report System (PQRS)Group Practice Reporting Option (GPRO)performance rates www.data.medicare.gov/physician-compare12
Quality Measure DataDate ofPublicationRule2012 PhysicianFee Schedule(PFS) FinalRuleFebruary20142012 MedicareSharedSavingsProgram (SSP)Final RulePQRS GPROsACOs2012 PQRS GPROmeasures collected viathe Web Interface2012 ACO measurescollected via the WebInterface for MedicareShared Savings Program(SSP) & Pioneer ACOs Diabetes Mellitus(DM) and CoronaryArtery Disease(CAD) measuresonly Diabetes Mellitus (DM)and Coronary ArteryDisease (CAD)measures onlyPatientExperience of CareMeasuresIndividual EligibleProfessionals(EPs)N/AN/A13
Quality Measure DataDate ule(PFS) FinalRulePQRS GPROsACOs2013 PQRS GPROmeasures collected viathe Web Interface2013 ACO measurescollected via the WebInterface DM and CAD DM and CADPatient Experience ofCare MeasuresIndividualEligibleProfessionals(EPs)2013 Clinician and GroupConsumer Assessment ofHealthcare Providers andSystems (CG-CAHPS) forACOs Group practices of 100 ormore EPs reporting viaWeb Interface- Not technically feasibleN/A CMS will administer datacollection14
Physician Compare Website Demohttp://medicare.gov/physiciancompare15
Public Reporting by YearDate ofPublicationRulePQRS GPROs2014 PQRS GPROmeasures collectedvia the WebInterface All measuresLate 2015*2014PhysicianFeeSchedule(PFS) FinalRule2014 PQRS GPROdata collected viaRegistry and EHR Sub-set ofMeasuresACOs2014 ACO measurescollected via theWeb Interface All measures3 claims-based and 1administrativeclaims measurePatient Experience ofCare MeasuresIndividual EligibleProfessionals (EPs)2014 CAHPS for PQRS andCAHPS for ACOs2014 PQRS measurescollected through anEHR, Registry, orClaims Group practices of 25-99EPs reporting via a CMSapproved certified surveyvendor Group practices of 100 ormore EPs reporting viathe Web Interface orother CMS-approved toolor interface CMS will administer datacollection for GPROsparticipating via the WebInterface and ACOs* If technically feasible Measures in linewith WebInterface measures Sub-set of 20possible measures2014 CardiovascularPrevention measuresgroup in support ofMillion Hearts16
Public Reporting by YearDate ofPublicationLate 2016*Rule2015PhysicianFeeSchedule(PFS) FinalRulePQRS GPROsAll 2015 PQRSGPRO measurescollected via theWeb Interface,Registry, and EHR Minimumsample size of20 patients.* All data will be reported if technically feasible.ACOsAll 2015 measuresreported by ACOsregardless ofreportingmechanism Minimum samplesize of 20patients.Patient Experience ofCare MeasuresIndividual EligibleProfessionals (EPs)2015 CAHPS for PQRS andCAHPS for ACOsAll 2015 PQRSmeasures collectedvia an EHR, Registry,or Claims Group practices of 2 ormore EPs and ACOsreporting via a CMSapproved certified surveyvendor.2015 Individual PQRSmeasures in supportof Million Hearts.2015 QCDR measures Individual EPlevel. PQRS and NonPQRS measures. No first yearmeasures.
Benchmarking Evaluating options for a publicly reportedbenchmark Stakeholders engagement– Suggestions may be sent toPhysicianCompare@Westat.com– All suggestions received by Tuesday, March 3,2015 may be considered in development of the2016 PFS Proposed Rule18
For More Information Please direct inquiries regarding PhysicianCompare to PhysicianCompare@Westat.com Find additional information at CMS.gov – justsearch for “Physician Compare Initiative”19
Physician Compare Virtual Office Hour Session Author: Centers for Medicare and Medicaid Services \(CMS\) Subject: Physician Compare Overview and Background, Public Reporting Plan Keywords: Physician Compare, Virtual Office Hour Session, Overview and Background, Public Reporting Plan Created Date: 1/26/2015 3:33:09 PM
