Individual Clinicians Now Get Stars on Physician Compare Site

December 14, 2015

The report-carding of American medicine expanded on December 10 when Medicare introduced performance scores on six quality-of-care measures for more than 40,000 individual clinicians on its Physician Compare website. Such scores, represented by the kind of stars seen in consumer product ratings, had been limited previously to group practices and accountable care organizations (ACOs).

The debut of stars for individual clinicians, long in the works, drew flak immediately from the American Medical Association (AMA), which views Physician Compare as not ready for prime time.

Created under the Affordable Care Act, the Physician Compare site is designed to help Medicare beneficiaries select a clinician and to spur clinicians on the giant shopping list to improve their quality of care. Initially, the site published basic information on physicians, such as contact information, training, board certification, and whether they participated in various Medicare incentive programs such as the Physician Quality Reporting System (PQRS), which is voluntary. Then, in February 2014, Medicare began posting 2012 scores on selected PQRS measures (there are more than 200 altogether) for ACOs and group practices on Physician Compare. Patient satisfaction scores derived from a PQRS survey called the Consumer Assessment of Healthcare Providers and Systems (CAHPS) were added in late 2014 for ACOs.

On December 10, the government refreshed Physician Compare data for group practices and ACOs to reflect PQRS performance in 2014 and added new measures for them as well, including eight from the CAHPS survey for some 290 group practices. But the big news was the addition of scores for individual clinicians on up to six PQRS measures oriented toward primary care:

  • Screening for an unhealthy body weight and developing a follow-up plan.

  • Screening for tobacco use and providing help on quitting when needed.

  • Screening for high blood pressure and developing a follow-up plan.

  • Screening for depression and developing a follow-up plan.

  • Comparing new and old medications.

  • Using aspirin or prescription medicines to reduce heart attacks and strokes.

Medicare calculates scores based on claims data. Clinicians receive up to five full or partial stars on a measure, depending how faithfully they meet the care standard. Each star represents 20% compliance, so four stars mean the clinician provided the service 80% of the time it was appropriate. The percentage figure also is posted.

How to Read the Stars

To head off any misunderstandings, CMS cautions on the Physician Compare website that not all clinicians report performance on the same PQRS metrics, and that a particular metric may not be reportable for a clinician, given the services he or she provides. Furthermore, Medicare beneficiaries should not conclude that a clinician reporting more PQRS measures than someone else delivers better care. For many clinicians on Physician Compare, there is only one measure listed.

Of course, the absence of performance scores for one or more PQRS measures for a given clinician also may reflect that he or she, similar to thousands of others, did not participate in the program in 2014.

In a news release, the Centers for Medicare & Medicaid Services added another caveat, saying that Physician Compare stars do not constitute a rating or ranking system "because they do not serve to benchmark or compare group practices or [individual clinicians] against one another." In other words, Physician Compare cannot be used to compare clinicians on quality of care.

For its part, the AMA thinks Physician Compare is plenty confusing. In a news release, AMA President Steven Stack, MD, warned that visitors to the website "are likely to get the 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."

Dr Stack conceded that the Centers for Medicare & Medicaid Services has tried to explain on the Physician Compare website that the data are not comprehensive, and that no one should assume a physician is deficient in clinical areas where PQRS data is lacking. "But the location of the disclaimer may not be obvious to patients," he said.

Dr Stack said that in light of "widespread accuracy issues with the 2014 PQRS calculations," the release of performance scores on individual clinicians was premature.

"The AMA is a strong supporter of transparency, but [the December 10] action goes in the opposite direction — offering the public information that will lead consumers to draw faulty inferences about the quality of care that an individual physician or group provides," he said.

More information about Physician Compare is available on the program's website.

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