The Affordable Care Act requires the federal government to post information about physician performance and quality of care on a public website. How’s it developing?
Measuring physician performance and quality of care is a critical component of the move to greater accountability and improved value in health care.
What’s the Issue?
Surveys show consumers have high interest in information that helps them evaluate and choose physicians. Insurers, employers, and government are increasingly tracking physician performance—for quality improvement, network creation, contract negotiations, and payment incentive initiatives.
The federal government significantly enhanced its presence in this realm with the launch in 2010 of Physician Compare, a website mandated by the Affordable Care Act (ACA). Additionally, in April 2015 a new law—the Medicare Access and CHIP Reauthorization Act (MACRA)—altered the landscape of physician quality measurement and payment beginning in 2019. MACRA accelerates Medicare’s shift away from fee-for-service physician payment toward payment based on performance assessment, quality metrics, patient outcomes, and patient experience. As they take effect, many of those quality metrics will be added to Physician Compare.
This brief focuses on the rollout and evolution of Physician Compare to date and plans for the site in 2016 and beyond. An earlier version of this brief—pre-MACRA—was published in December 2014.
Physician Compare follows in the tradition of Hospital Compare, Nursing Home Compare, Home Health Compare, and Dialysis Facility Compare. Those earlier-established sites have evolved significantly over the past decade and now encompass thousands of facilities nationwide, including every acute care hospital in the nation and almost 16,000 nursing homes.
These sites are credited with advancing accountability and motivating improvements in care and quality. But they are also widely viewed as poorly organized, inadequately audited when data are submitted by facilities, and underused by consumers. As a result, the sites are not as useful and impactful as they could be.
Under the ACA and subsequent legislation, including MACRA, the Centers for Medicare and Medicaid Services (CMS) is required to make all the “compare” sites more consumer-friendly. For example, in April 2015 CMS began posting on Hospital Compare five-star ratings of hospitals based on eleven measures of patient experience, using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) tool. The ratings encompassed 4,167 hospitals and were based on 3.1 million consumer surveys. The ratings will be updated quarterly. Five-star ratings are also now being used on the Dialysis Facility Compare and the Home Health Compare sites.
Physician Compare is being updated amid these positive changes, and it also now has five-star ratings of a small number of physician groups.
Physician Compare is a work in progress. It has the potential to be an important source of information and empowerment for consumers and a significant driver of choice, competition, and health care improvement. CMS has learned much in recent years through its management of Hospital Compare and affiliated sites, and the launch of the insurance plan comparison site HealthCare.gov. But many obstacles remain. The posting of clinical quality and outcome measures will raise the stakes for physicians, and it’s not likely that there will be easy agreement on how Physician Compare should roll out in 2016 and beyond, perhaps especially as MACRA is implemented. Absent a significant upgrade in the site’s usability and aggressive marketing to make consumers aware of it, the site likely won’t reach a wide audience for years to come.