For decades, pundits, policymakers and consumer groups have called for better tools to make health care purchasing decisions easier. Greater cost transparency and clear indicators of quality, they say, would help consumers make the right choices, which would lead to lower costs and better quality care.
If only it were as easy as using Angie’s List: describe the need and up pops the names of local providers, along with comparative information on their performance.
Increasingly, such information and tools are available. But their impact is unclear.
Since 2010, Medicare consumers have had an “Angie’s List” type of resource in Physician Compare, an online service produced by the Centers for Medicare and Medicaid Services (CMS). The website was mandated by the Patient Protection and Affordable Care Act (ACA). It serves a two-fold purpose, according to CMS:
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Provide information to help people with Medicare make informed decisions; and
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Incentivize clinicians and groups to maximize their performance.
Since its birth, CMS updated the website, adding measures reflecting the quality of care and patient experience. The underlying data source for Physician Compare is the Medicare Provider Enrollment, Chain and Ownership System (PECOS), the system Medicare uses to enroll and revalidate physicians and clinicians. In 2017, Physician Compare introduced star ratings to a subset of group-level data, advancing beyond original PECOS data to consumer-friendly measures of performance.
Recently, CMS posted an update to the Physician Compare goals and milestones. In its posting, CMS highlighted more recent updates, including a new comparison tool giving consumers the ability to compare up to three clinicians or groups on basic information such as distance, Medicare assignment and specialty information.
A companion CMS resource, Hospital Compare, has its origins in efforts by CMS and the Hospital Quality Alliance to promote hospital quality data. Like Physician Compare, the hospital tool is designed to make it easier for health care consumers to make decisions about hospital care and to improve hospital quality in the U.S. The first Hospital Compare data were posted in 2005. On February 28, 2019, CMS updated the hospital performance data on the Hospital Compare website.
And just as CMS is making progress in presenting physician quality data, the agency is also taking steps to make health care prices more transparent. CMS’ 2018 Inpatient Prospective Payment System rule requires hospitals to publish online their standard charges, beginning January 1, 2019.
The future of public reporting of physician performance measures will depend in part on physician acceptance. According to an analysis in 2016 in Health Affairs, U.S. physician practices at the time were spending $15.4 billion each year to report performance data. It took more than 785 hours of staff and physician time per physician per year, and yet fewer than a third of the physicians felt the reported measures reflected the quality of care they provide.
An American College of Physicians study published in the New England Journal of Medicine in 2018 found only 37% of the performance measures reviewed were rated as valid, while 35% were deemed not valid and 28% were identified as having uncertain validity. The analyzed measures related to ambulatory general internal medicine and were taken from the Medicare Merit-based Incentive Payment System/Quality Payment Program.
Given the financial and time burden on physicians to report performance data, and concerns about the validity of the reported measures, it is not surprising that physicians are resistant. Yet the trend toward performance measurement and reporting is growing. As Forbes reported in 2018, 43% of MerrittHawkins’ clients offering physicians a production bonus in 2017 based the incentive payment at least in part on patient satisfaction and outcome measures, an increase from 39% in 2016 and 32% in 2015. Last year, the Medical Group Management Association found 36% of medical practice leaders said they linked physician compensation plans to quality performance metrics, up from 26% two years earlier.
Whether Physician Compare and other provider performance resources ultimately drive improvements in cost and quality remains uncertain. To date, there isn’t much evidence that performance measures are moving the needle. A 2017 study by the United Hospital Fund of New York found that websites presenting provider quality information lacked the meaningful quality measures consumers need to make informed choices. Nevertheless, as costs continue to rise and consumer demand for a better way remains, regulators and large purchasers are likely to continue their development toward the “Angie’s List” of health care.
