At the moment, the federal government's Physician Compare Web site provides no information that allows a patient to compare one neurologist to another. That will not be the case forever.
The Centers for Medicare & Medicaid Services (CMS), which launched the Web site, www.medicare.gov/find-a-doctor, late last year, intends to create a resource that allows patients to compare physicians based on the quality of care they provide.
“Our goal is to have a robust Web site with information on performance so the public could…use the information to select which physician they want to go to,” said Michael T. Rapp, MD, director of the CMS Quality Measurement and Health Assessment Group.
Currently, the site provides only bare-bones information — just an address for some physicians — but Dr. Rapp said it will eventually include quality measures as well as measures of efficiency and patient satisfaction.
“The vision for the longer term is quite expansive,” he said.
WHO LIKES IT, WHO DOESN‘T
That sounds good to consumer champions like Steven Findlay, senior health policy analyst at Consumers Union.
“Policymakers understand that people really want information…that will help them choose a doctor, particularly specialists, surgeons, etc.,” he said. “I think it has a lot of potential, and hopefully the physician community will be a force for making it a useful, meaningful site.”
But Christopher Bever Jr., MD, MBA, chair of the AAN Quality Measurement and Reporting Subcommittee, has his doubts about the effort.
“I am not convinced that the Physician Compare Web site is an effective way to improve the quality and efficiency of neurological care,” he said in an e-mail interview with Neurology Today. “And, based on the experience thus far, I am concerned about the ability of CMS to implement a Web site that is accurate and transparent.”
The American Medical Association, in comments at a CMS town hall meeting about the Physician Compare Web site last fall, cast the same doubt — and went further. It does not believe current statistical methods allow for accurate reporting of physician-level quality measures, which undermines the basic premise of Physician Compare.
“To minimize unintended consequences, the initial phases of public reporting should be limited to group or organizational level reporting,” the AMA wrote.
But a group of 34 organizations — including the National Business Group on Health, Leapfrog Group, and Consumers Union — representing consumer, labor, and purchasers urged CMS to proceed aggressively with Physician Compare's basic goal.
“Some may say that the science behind assessing individual physician reporting is not ready for consumer consumption. However, the science has been continuously improving,” the groups, acting under the umbrella of the Consumer-Purchaser Disclosure Project, told CMS.
They contend that reliable and valid individual-level performance data can be achieved by using data aggregated across payers or over a period of years.
HISTORY BEHIND THE CMS SITE
Although the CMS has advanced other comparative-data initiatives — Hospital Compare, Home Health Compare, and Nursing Home Compare Web sites all publish quality data that can be used to compare providers — the agency did not launch Physician Compare until Congress mandated it.
The Affordable Care Act instructed the Web site to go live by Jan. 1, 2011, but it restricts the type of data that can be posted. The law allows CMS to publicly report that a physician is participating in a government reporting effort, but it cannot publish actual performance data until 2013 for the quality of care delivered in 2012.
Dr. Rapp expects the Physician Quality Reporting System (PQRS), the CMS four-year-old pay-for-reporting program, to become a primary source of quality data for Physician Compare.
That is where Dr. Bever's concern comes in.
Since 2007, CMS has been trying to get physicians to voluntarily report quality measures through the PQRS program. (The program was called Physician Quality Reporting Initiative, or PQRI, until it became a permanent program last year.)
CMS has offered a small financial incentive to participate in the pay-for-reporting initiative — the physicians‘ actual performance has not been evaluated or posted publicly — as a way of preparing them for the day that their quality scores would be posted publicly.
Although participation has grown each year, the majority of neurologists have ignored PQRS — and many of those who have participated have not been pleased with the experience.
Dr. Bever pointed out that PQRS, which includes many measures focused on preventive care and chronic conditions such as diabetes and heart disease, does not include enough measures that are relevant to neurology to allow comparison from one neurologist to the next.
“The measures might be helpful to healthy patients seeking good primary care or patients suffering from the high-volume conditions but would not be helpful for less common conditions, such as neurological conditions, where care is not measured,” he said.
Additionally, the PQRS program has frustrated many neurologists because CMS has been slow in making payouts to physicians who successfully submitted quality data. Further, those who have not earned the incentive for participating have generally been unable to learn why.
“The second big issue is whether CMS can carry out what has been mandated (regarding Physician Compare),” Dr. Bever said. “The experience with the PQRS program would suggest that this will be a challenge for them.”
Findlay, the consumer advocate, agrees that PQRS has been problem-plagued to the point that it might have to be scrapped entirely. But that would not doom Physician Compare, which could use quality measures from other sources, such as the “meaningful use” incentive program to encourage physicians‘ use of electronic health records.
More broadly, Findlay said, the basic idea behind Physician Compare — that patients should be able to know the quality of care physicians provide — is bigger than the federal government. In addition to private payers‘ efforts to provide comparative information about physicians, the Robert Wood Johnson Foundation is funding Aligning Forces for Quality, a huge initiative in 17 communities that is experimenting with ways to measure and report the quality of care delivered by physicians.
Dr. Bever questions whether patients are really interested in comparative data. “There is a more than a 10-year history of public reporting programs that have demonstrated that consumers are relatively insensitive to them,” he said.
IMPLICATIONS FOR HYSICIAN PAY
In addition to helping patients choose high-quality physicians, CMS also will start using a “value modifier” in 2017 to calculate physician pay based on the quality of care provided.
“There's no direct provision that the only measures that we could use for the value modifier comes from Physician Compare,” Dr. Rapp said. “But certainly one would expect [Physician Compare and a value-based purchasing program] to have a great deal of overlap.”
WHAT TO DO NOW
Unless something changes, PQRS data on physicians will eventually be posted publicly so Dr. Bever encourages neurologists to review their reports for accuracy.
Findlay at Consumers‘ Union is hoping physicians will become more engaged in quality improvement and reporting efforts.
“We‘re certainly going to be telling consumers that you need to ask your physicians whether they are participating in these kinds of things,” he said. “I think physicians that don‘t do that over the next four or five years are going to be put at a disadvantage, and hopefully part of that disadvantage will be that patients will begin to say, ‘You know, I just think I‘m going to go to another doctor who values this.‘”
FOR MORE ON PHYSICIAN RATING MEASURES
Neurology Today has reported on efforts to mandate physician adherence to quality standards and ratings for several years. Visit these stories on neurotodayonline.com:
- AAN Develops Quality Measures for Neurology for Parkinson Disease, Dec. 2, 2010: http://bit.ly/e5Qn4M
- The Physician Quality Reporting Initiative: The Good, the Bad, and the Ugly, Sept. 8, 2008: http://bit.ly/hiPduO
- It's Not Too Late to Participate in PQRI for 2010, April 1, 2010:http://bit.ly/gTndar
- Medicare Offers Pay-for-Performance Incentive, Jan. 16, 2007:http://bit.ly/emZFZq
- Federal Pay-for-Reporting Program Likely to Continue Despite Physician Complaints: New Performance Measures for Neurology, Aug. 3, 2009: http://bit.ly/g0wBE1