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Anatomy of Physician Compare

Physician Compare is the CMS site that provides public data about clinicians and groups. This information is available to literally anyone who visits the site (patients! competing groups! groups that want to buy you! your mom!), so it's in your best interest to at least be aware of what's out there about you.


There are really two parts to Physician Compare: the profile page and the downloadable data sets.


Profile Page



This is where the government expects patients to go to look doctors up.


It requires both a location and a search term for a specific physician, specialty, body part, or disease. If I enter Austin, Texas and primary care, I get:



The list of results lets you filter by location, Medicare payment, gender, practice type, and board certification.


Once you click on a specific physician, there’s demographic information about the doctor and a blurb that talks about how important quality activities are.



If you have any data on the Profile Page, this is where it will show up.


In 2019, 2017 data is shown for 11 measures only from Qualified Clinical Data Registries (QCDRs). These are usually specialty or national registries, and most physicians will have zero to two measures that are applicable. Currently there are no MIPS measures in the public profile page, though there likely will be in coming years. QCDRs are different from the MIPS measures because they aren’t necessarily tied to payment in the Medicare system.


That’s all well and good, but for a lot of clinicians there won’t be anything more than demographic data on the profile page. The publicly downloadable dataset has a ton more information.


This is where the real meat is.


Downloadable files

There are five downloadable Excel spreadsheets available:


  • Physician Compare National Downloadable File

  • Basic demographic information about clinicians from PECOS

  • Changes to this data can be made via the Medicare Provider Enrollment, Claim, and Ownership System (PECOS).


  • Physician Compare Individual EP Public Reporting

  • Individual clinician quality metrics


  • Physician Compare Group Public Reporting

  • Group quality metrics


  • Physician Compare 2016 Group Public Reporting - Patient Experience

  • Group patient experience metrics


  • Physician Compare Clinician Utilization Data

  • How many times clinicians performed specific procedures or tests


For all the screenshots below I’ve omitted the first few rows that identify the clinicians or groups.


Physician Compare Individual EP Public Reporting

We’ll start with the database “Physician Compare Individual EP Public Reporting”. There are 108 physician-specific quality measures from 2017 data (published in 2019).


All the rows are grouped by NPI number.


Measure ID: This is how CMS refers to the measure if you need specifics on how that measure is calculated.


Measure Title: This is a short description of the measure


Invs_msr: This is a not-very-intuitive name to designate whether a lower number is better, like for an infection rate, rather than a higher number being better, like for a screening rate.


Prf rate: The percentage of patients who had whatever the metric is measuring (influenza immunization, for example)


Patient_count: Number of patients the performance rate is based on.


Collection_type: This is where CMS is getting its data. CLM is claims, which is the most common. QCDR is a qualified clinical data registry, and REG is from registry data.

live_site_IND: Y means the data is listed on the Physician Compare Profile Page, and N means it’s not.



Physician Compare Group Public Reporting

Next is “Physician Compare Group Public Reporting”. The way these are reported depends on whether the group is part of an accountable care organization (ACO), which is why there are blanks for the measures when a group has an ACO listed. The ACOs report differently.

The group quality reports have the interesting feature of having a star rating and the “five star benchmark” listed. The star rating (star_value) and benchmark (five_star_benchmark) are decided by CMS based on the performance rate (prf_rate).



Group Patient Experience

Then we have Group Patient Experience. These are based on Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores. For most clinicians these will be only inpatients, though there are specialty surveys for conditions like hospice and dialysis. Again, we have performance rate and patient count, though no star ratings for this one.



Physician Compare Clinician Utilization Data

Finally, we have Physician Compare Clinician Utilization Data. This one lists specific procedures, how many times they’ve been billed by a specific clinician (line_srvc_cnt), and for how many patients (bene_cnt).



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