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Get Ready for Physician Compare

December 9, 2010 | No Comments
Posted by Beth Christian

Hospitals have had to report quality data, which is made available to the public on the CMS Hospital Compare website, for some time.  Pursuant to Section 10331 of the Patient Protection and Affordable Care Act (“PPACA”), data applicable to physician performance will also be collected and made available for review by the public.  In addition to physician reporting, reporting may also occur for physician assistants; nurse practitioners and clinical nurse specialists; CRNAs; nurse midwives; clinical social workers; clinical psychologists; registered dieticians; nutrition professionals; audiologists; physical therapists; occupational therapists; and qualified speech-language therapists.

PPACA requires the Secretary of Health and Human Services (“HHS”) to develop a Physician Compare internet website no later than January 1, 2011.  However, public access to data regarding individual physicians and other healthcare professionals will not occur until January 1, 2013.  As of that date, the Secretary of HHS will be required to implement a plan to make available to the public information on physician performance that provides comparable information on quality and patient experience measures for physicians enrolled in the Medicare program.  Reporting will include (to the extent practicable) the following:  (1) measures collected under the Physician Quality Reporting System; (2) an assessment of patient health outcomes and the functional status of patients; (3) an assessment of the continuity and coordination of care and care transitions, including episodes of care and risk-adjusted resource use; (4) an assessment of efficiency; (5) an assessment of patient experience and patient, caregiver and family engagement; (6) an assessment of the safety, effectiveness, and timeliness of care; and (7) other information as determined appropriate by the Secretary of HHS.

PPACA also requires CMS (to the extent practicable) to consider the following in developing the Physician Compare website, data collection and reporting process:  (1) processes to assure that data made public is statistically valid and reliable, including risk adjustment methodology; (2) processes by which a physician or other eligible professional has reasonable opportunity to review his or her individual results before they are made public; (3) processes to assure that the data made available to the public provides a robust and accurate portrayal of a physician’s performance; (4) data that reflects the care provided to all patients by the physician under both the Medicare program and, to the extent practicable, other payors; (5) processes to ensure appropriate attribution of care; (6) processes to ensure timely statistical performance feedback; (7) implementation of computer and data systems to support valid, reliable and accurate public reporting activities. 

The statute also requires the Secretary of HHS to take into consideration input provided by multiple stakeholder groups in selecting quality measures for use under the statute.  As a result, CMS is seeking input on certain aspects of the Physician Compare program before implementing it and held a town meeting on October 27th to solicit input. 

Physicians and other healthcare professionals will need to consider a number of issues as the Physician Compare program is rolled out.  One of these issues is how to best address questions raised by patients after they evaluate a physician’s individual results on Physician Compare.  Another issue that should be reviewed is the extent to which a physician’s results as reported on the Physician Compare website may impact the use of performance-based criteria contained in healthcare professional employment contracts, shareholder agreements, or practice operating agreements.  As part of our work in drafting physician contracts, we have seen a significant shift toward the use of quality metrics for evaluating healthcare professional performance.  In addition, information published via Physician Compare may impact physician credentialing decisions, and the use of this information may necessitate future modifications to a healthcare facility’s medical staff bylaws.  We have already seen the impact of the use of quality-driven measures through our work handling credentialing matters and in working with healthcare facilities regarding bylaw modifications.  It will be interesting to see how reporting on Physician Compare will impact physicians and their relationships with their patients, as well as relationships between providers in a professional practice, and the role of physicians as members of a healthcare facility’s medical staff.

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