Need to Know: New Physician Star Ratings

Is it true that doctor ratings are becoming a thing?”

Beginning with 2016 PQRS data, and continuing into MIPS, CMS is launching and expanding an initiative to publish public star ratings to help patients and the public evaluate provider quality, referred to as the new “ABC Benchmark.” This is a large and important shift–these star ratings will not only be searchable on the Physician Compare website, data will also be downloadable for use by other companies and websites that publish ratings–think Yelp or Zocdoc.

Given these changes, provider groups are focusing more than ever on achieving high performance, because in addition to dollars, reputations are now at stake. Able Health is here with the critical information you need to know as we enter a new era of public star ratings for providers.

What will the star ratings look like?

Beginning this year, between one and five stars will be displayed next to some publicly reported quality measures on Physician Compare. The number of stars displayed for each organization or eligible clinician will be based on your measure performance relative to the performance of all other groups and individual eligible clinicians who submitted data for that measure.

When will this start?

The first star ratings will be based on 2016 PQRS data, and will go live to the public in late 2017. There will be a 30-day preview period where providers can preview the data that will be made public, open between October 18th, 2017 and November 17th, 2017. You can use this lookup tool from CMS to see if you have measures available for preview.

Will we get rated on all measures that we reported?

No. CMS is using a process to determine which measures have enough data submitted to assign a reliable star rating. For the 2016 PQRS data that will be publicly released at the end of this year, CMS will only put star ratings next to the following measures, and only at the group level:

  • 006: Giving antiplatelet blood thinners to patients with heart disease. (Registry)
  • 047: Older patients who have an advanced care plan or someone to help make medical decisions for them when they can’t. (Registry)
  • 048: Evaluating loss of bladder control in older women. (Registry)
  • 051: Spirometry evaluations in patients with COPD. (Registry)
  • 110: Getting a flu shot during flu season. (Web Interface)
  • 111: Making sure older adults have gotten a pneumonia vaccine. (Web Interface)
  • 113: Screening for colorectal (colon or rectum) cancer. (Web Interface)
  • 117: Eye exam for patients with diabetes. (Web Interface)
  • 128: Screening for an unhealthy body weight and developing a follow-up plan. (Web Interface)
  • 134: Screening for depression and developing a follow-up plan. (Web Interface)
  • 226: Screening for tobacco use and providing help quitting when needed. (Registry)
  • 238: Limiting high-risk medicine use in older adults. (Registry)
  • 318: Screening older patients’ risk of falling. (Web Interface)
  • 412: Signed opioid treatment agreements for patients that are prescribed opioids. (Registry)
  • 438: Giving statin therapy to patients at risk for cardiovascular problems. (Web Interface)

CMS has indicated that this list of measures that will have star ratings will continue to expand each year.

Where are these stars going to be publicized?

Stars will be shown on Physician Compare, a public website maintained by CMS. In addition, these stars will be available in a downloadable data file for use by other individuals and organizations.

Physician Compare has both Group and Individual Clinician pages. Eventually, both group pages and individual eligible clinician pages will show star ratings for eligible measures.

  • For 2016 data, being released in late 2017, only the measures listed above will show a star rating, and only on group pages.
  • In the future, star ratings will be shown on both individual clinician and group pages, depending on how the data was reported. For data reported at the level of the individual eligible clinician, star ratings will be shown on the clinician page. For data reported at the group level, star ratings will be shown on the clinician page. Clinicians who report as part of a group will have a link on their clinician page to the associated group.

What can clinicians do to improve their scores?

Your star ratings for quality measures on Physician Compare will reflect the quality data you submit for MIPS. Using tools to track and improve your performance throughout the year can help ensure that you are satisfied with the data before it is made public.

 

To stay up to date on Physician Compare, MIPS, and the evolving landscape of healthcare quality, sign up for the Able Health newsletter!


Further reading:
Help! I can’t find six relevant MIPS measures for my specialty
Expert Commentary: Nathan Bays on MACRA in 2018

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