Introduction to the Physician Compare Initiative

August 6, 2018 by admin0
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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.

Changes to Physician Compare Website

Presently, 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 The website does say whether or not a physician participated in the outdated Physician Quality Reporting System (PQRS) program and the most recent information on the site is from 2016. Doctors supporting the Million Hearts initiative by the Department of Health and Human Services (HHS) are also identified.

However is this about to change?

CMS has declared that it will soon make available the MIPS score of all eligible providers on its website. Provider scores in each of the performance category, i.e., Quality, Cost, Promoting Interoperability, and Improvement Activities will be posted on the site based on 2017 performance scores. The data will be available in downloadable file format free for use by online directories and health information websites like Yelp, Zocdoc, Healthgrades, and Vitals, etc.

Reputation Impact of Physician 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, the 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. 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 proofs 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 it to CMS via the contact information provided on the website.

How Can P3 Healthcare Solutions help?

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 in the website. Furthermore, healthcare providers will only learn about their MIPS score for the performance year 2018 by late 2019. That means when they learn about a 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. It means that not only the incentive payments will continue to get hurt, the reputation impact will also continue until at least the end of 2020.

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 expert today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.

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Copyright by P3 Care Healthcare Solution 2018. All rights reserved.





Copyright by P3 Care Healthcare Solution 2018. All rights reserved.



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