Starting next year, Medicare will begin publicly displaying group-level physician performance data. The data will come from the voluntary Physician Quality Reporting System (PQRS) and will be posted on the new Physician Compare website, as required by the Affordable Care Act.
The Centers for Medicare and Medicaid Services launched the Physician Compare website in January 2011; it currently displays mostly biographical information on physicians who accept Medicare patients. It also lists physicians who have successfully reported quality data to the agency through the PQRS. Beginning next January, CMS will add quality measure performance rates for group practices that voluntarily submitted data this year under the PQRS. The agency will only post data on measures that have at least a 35-patient sample size.
Dr. Glen R. Stream, president of the American Academy of Family Physicians, shared his views on how this information might be used by physicians and patients.
Question: Doctors have raised concerns about errors and inaccurate information on Physician Compare since it launched in 2011. Does the site provide a valuable service for patients?
Dr. Stream: It’s not surprising that in a database this large there would be some inaccurate or incomplete information. That was certainly one of the concerns for the AAFP. The challenge is to make sure this information is presented in a way that it can be understood, interpreted, and potentially acted on by the public. A lot of these quality measures are data that people in the health care industry understand but the general public may not. And that means that the expectations for performance may be different. A good performance on a given quality metric might be 50%, but a patient is going to look at that and say, "When I went to school 50% was an F." So the inclusion of some comparative data may be necessary. For instance, many reporting tools compare an individual physician or a medical group’s performance to the average performance of the entire data set. Or they clearly show what the target was and whether that group or person met it.
Question: CMS officials have said that they will begin the public reporting of quality data with group-level data rather than physician-level data. What’s the downside to using information about individuals?
Dr. Stream: One of the challenges when you get down to individual physician reporting is, do you have a sufficient number of patients in that category to have meaningful information? If I have 15 diabetic patients and my endocrinology colleague has 1,000, it’s hard to compare those two data sets. For example, I get a quality report card from one of the regional insurers in Washington state, where I practice, and when I get that report card it will say that I have X percent achievement of a certain quality metric. But it will also have an asterisk indicating whether there is actually a statistically valid number of patients in that metric. It may be that I got a great score, but if I have just four patients and they all met the metric, that’s not a valid number.
Question: Is performance in the PQRS the right data to use for public reporting?
Dr. Stream: Overall, I would say that the quality metrics that are in the PQRS quality data set are good ones. There are certainly some that could be improved. But the quality improvement on the measures themselves is ongoing, just like the quality improvement in the health care delivery to achieve them.
Question: Do you think that this type of public reporting will be an effective lever for changing physician behavior and improving care?
Dr. Stream: I think that’s a question to be answered over time. My personal opinion is that comparative information between physicians and medical groups has much more of an influence on the physicians and the medical groups than it does on the patients. Physicians are by nature competitive perfectionists. I want my quality metrics to be at the 99th percentile because I believe I’m a really good doctor and I want my metrics to reflect that. The transparency of this information from one physician and one medical group to another is perhaps more important than the public availability of it. My personal experience so far is that there are already a number of sites out there – some that are consumer sponsored and some that are health plan sponsored – that rate physicians. But most often patients choose specialty physicians based on the recommendation of their primary care physician. And otherwise they choose doctors based on the recommendations of friends, neighbors, and family.