The Centers for Medicare & Medicaid Services (CMS) is giving patients and their families new resources to learn about physicians and certain other health care providers.  On December 30, 2010, CMS added a new “Physician Compare” feature to the CMS Healthcare Provider Directory.  While the information provided currently is relatively limited, CMS plans to expand the data to help Medicare and non-Medicare patients and their families find and assess the quality of providers.   While these and other similar resources can provide valuable information for patients and their families, like all provider directories, patients and their families should be cautioned to properly understand the benefits and limitations of the resource.  Accordingly, physicians and other providers covered by the new tool should be aware of the tool and prepare to respond to questions and concerns that it may prompt.  Physicians and other providers also should monitor proposed future expansions of this resource and provide input about the proposed content, format and presentation of such information.

Required by the Patient Protection & Affordable Care Act (“Affordable Care Act”), the Physician Compare tool located here has information about Doctors of Medicine, Osteopathy, Optometry, Podiatric Medicine, and Chiropractic and certain other types of health care professionals participating in the Medicare Program, who routinely care for Medicare beneficiaries.

According to CMS, the Physician Compare Web Site is designed to be consumer friendly and help all patients—whether on Medicare or not—locate health professionals in their communities. The information on the site includes contact and address information for offices, the professional’s medical specialty, where the professional completed his or her degree as well as residency or other clinical training, whether the professional speaks a foreign language, and the professional’s gender.  The tool can also help Medicare beneficiaries find out which physicians that see Medicare patients.

In addition to information about the physician’s practice, Physician Compare also shows consumers whether the practice reported certain data to CMS through the Physician Quality Reporting System, formerly known as the Physician Quality Reporting Initiative (PQRI). Currently, the PQRI reporting system is a voluntary reporting program that rewards physicians and other eligible healthcare professionals for reporting data on quality measures related to services furnished to Medicare beneficiaries.  These quality measures are based on the best available medical evidence and designed to help professionals improve care for patients. In 2009, over 200,000 professionals reported data to CMS through the Physician Quality Reporting System.

According to CMS, it plans a second phase of the Web site which will indicate whether professionals chose to participate in a voluntary effort with the Agency to encourage doctors to prescribe medicines electronically, rather than through traditional paper-based prescription methods later in 2011.

In future years, the Physician Compare Web site will be expanded with information about the quality of care Medicare beneficiaries receive from physicians and the other healthcare professionals profiled on the site.  The expansion will include information on quality of care and patient experience that can help consumers learn more about the care provided by Medicare-participating physicians.  CMS is required by the Affordable Care Act to develop a plan to implement this expansion by 2013.

The new Physician Compare resource supplements a broad range of resources that patients and their families can use to gather information about an existing or proposed health care provider.  Like all directories, however, patients and their families should keep in mind that no single resource or directory provides complete information about any one provider or should be used as a sole basis for selecting or assessing the quality or credentials of any health care provider.

Help patients and their families to constructively use these and other tools by managing your reputation and sharing information with patients and their families about how to properly use and understand the information provided.  You also can share your input about how patients and their families should use these and other similar resources and other insights to help other patients and their families better prepare to manage and assist in their own health care and health benefit management by participating in Project COPE: Coalition for Patient Empowerment here. 

For More Information Or Assistance

If you need assistance reviewing or responding to the DEA prescribing guidance contained in the Statement or addressing other health care related risk management or compliance concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 23 years experience advising health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients to establish and administer compliance and risk management policies and to respond to DEA and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Solutions Law Press publications authored by Ms. Stamer including:

• CMS Delegated Lead Responsibility For Development of New Affordable Care Act-Required Medicare Self-Referral Disclosure Protocol
• HHS announces Rules Implementing Tools Added By Affordable Care Act to Prevent Federal Health Program Fraud
• OIG: Texas Overbilled Medicaid for Medical Transportation Costs
• DMEPOS Suppliers Face 9/27 Deadline To Meet Tightened Medicare Standards
• Initial EHR Certification Bodies Named
• HHS Announces Adjustments to Federal Medical Assistance Percentage (FMAP) Rates
• CMS Publishes Corrections To Proposed 2011 Physician Fee Schedule Rules
• Medicare Changing How It Pays For Outpatient Dialysis
• Last Call: Today Deadline To Comment on Proposed Edits To CMS Nursing Home Civil Monetary Penalty Regs
• Rite Aid Agrees to Pay $1 Million to Settle HIPAA Privacy Case As OCR Moves To Tighten Privacy Rules
• HHS Invites Input On Medicaid Changes To Promote Children’s Health Quality
• CMS Adopts ESRD Facility Prospective Payment System & Proposes New Quality Incentive Program
• CMS Rule Clarifies When Outpatient Services Subject to 3-Day Rule & Finalizes FY 2011 Inpatient Payment Rates
• New Affordable Care Act Mandated High Risk Pre-Existing Condition Insurance Pool Program Regulations Set Program Rules, Prohibit Plan Dumping of High Risk Members
• CMS & ONC To Co-Host 7/22 ONC Certification & Medicare/Medicaid EHR Incentive Program Audio Training
• CMS Proposes Changes To Civil Monetary Penalty Rules For Nursing Homes

For More Information

We hope that this information is useful to you. If you need assistance evaluating or responding to the Health Care Reform Law or health care compliance, risk management, transactional, operational, reimbursement, or public policy concerns, please contact the author of this update, Cynthia Marcotte Stamer, at (469) 767-8872 or via e-mail here.

You can review other recent health care and internal controls resources and additional information about the health industry and other experience of Ms. Stamer here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here.

©2011 Cynthia Marcotte Stamer.  Limited right to republish granted to Solutions Law Press.  All other rights reserved.

This entry was posted on Tuesday, January 4th, 2011 at 10:53 pm and is filed under Affordable Care Act, Conditions of Participation, Consumer Driven Health Care, Doctor, Evidence Based Medicine, Health Care, Health Care Finance, Health Care Provider, Health Care Quality, Health Care Reform, Health Plan, Health Plans, Medicare, Medicare Advantage, Physician, Reimbursement. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.