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Understanding How Data Can Affect Your Practice Reputation

By Featured article

At the end of May, the Centers for Medicare & Medicaid Services (CMS) announced that the 2016 performance scores in the Physician Compare Downloadable Database were available for download at

According to CMS, what you can find in the Downloadable Database includes:

• 2016 Physician Quality Reporting System (PQRS) measures for clinicians and groups
• 2016 Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS summary survey measures for groups
• 2016 non-PQRS Qualified Clinical Data Registry (QCDR) measures for clinicians and groups
• Subset of 2015 utilization data for clinicians

The 2016 performance scores for the group-level measures publicly reported as star ratings and those CAHPS for PQRS and non-PQRS QCDR measures that met the public reporting standards have also been updated on Physician Compare public-facing profile pages. Any cases that were suppressed due to an open Informal Review and were deemed suitable for public reporting are now available on the Physician Compare website. For more information about quality measures and public reporting, and a detailed list of the measures publicly available, visit the Physician Compare Initiative page. (This information was taken from a CMS email update received on May 31, 2018.)

That information will give you an indication of where you stand against other clinicians in your area and/or specialty.

But what does this really mean for your practice – and how do you use data like this?

Your practice should be reviewing its CMS submission information as well as any additional performance data you collect through the year. Why is that important? It is possible you have a clinician who is not “buying into” the MIPS reporting process. Maybe they are hoping that CMS will change its mind or they think that their data won’t make a significant impact on the practice.

If you have one provider performing at a high level (with a 90+ MIPS performance score) and another provider at a 60 percent performance score, you can see what one low score will do to the averages for the practice. Not only will it affect reimbursement rates, but also reputation when your information is uploaded to the Physician Compare website. Reputationally, it could cost the practice referrals, patients and even third-party insurers who may elect not to carry under performers.

As more and more patients browse websites to see physician scores (it is reported that 65 percent of consumers are aware of these grading websites), it could cost practices a lot - including their business.
If you are looking for help in understanding your data or investigating the possible “course corrections” for your providers, the Quality Reporting Engagement Group can help. With more than 25 combined years of experience and 125 successful audits, the team of experts understands your practice’s needs. To learn more, email us at or call 877.570.8721, x2.