Beware Physician Compare: Medicare site inaccurate, say wronged practices

Doctors say if CMS can't get simple biographical information right, expanding the website to include quality scores by 2013 might not produce a trustworthy resource.

By Charles Fiegl — Posted May 9, 2011

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Doctors and other health professionals have been disheartened with what they've found out about themselves on Medicare's Physician Compare website. Name misspellings, locality mistakes and other errors have physicians questioning the integrity and accuracy of the information on the site and wondering if it can become a legitimate comparison tool for health care consumers.

The Centers for Medicare & Medicaid Services launched Physician Compare on Dec. 30, 2010. The agency did so after expanding its physician directory on the Medicare program's website. The health system reform law required CMS to offer such a site to patients by 2011 and expand the site to include physician quality performance information by 2013.

Physician Compare displays a doctor's name, practice location, phone number, Medicare participation status, gender and any foreign languages spoken. A patient also can view the doctor's education and see if he or she successfully participated in Medicare's Physician Quality Reporting System in 2009.

But physicians, other health professionals and office staff checking their own information on the site found numerous errors shortly after the launch date.

Only four of the 14 physicians at Midlands Orthopaedics, PA, in Columbia, S.C., can be found on the website as being a part of the practice, said Midlands CEO AnnMargaret McCraw. In addition, two physicians no longer with the practice -- one who left in 2004 and the other who left in 2007 -- still appear to be a part of the group to anyone searching for them online.

McCraw and the group's human resources specialist, Kimberly Chapman, have attempted to correct the online directory without success.

"I have no objection to the concept of the Physician Compare website as a resource for patients if we could rely on the information presented there to be accurate," McCraw said. "The lack of effective and timely assistance we have received in response to our questions, as well as the lack of coordination among the entities supposedly involved in the Physician Compare website, is maddening."

The American Medical Association recently solicited feedback from physicians about the site, and numerous practices from all over the U.S. reported that information was incorrect or missing. Typical errors were name misspellings, the inclusion of physicians who either had retired or died, and incorrect Medicare participation status.

The mistakes are not confined to physicians in Part B. Rodney Peele, assistant director of regulatory policy and outreach at the American Optometric Assn., outlined two main problems his association's members have seen. One is that optometrists participating in the Medicare program who had complete enrollment records in the agency's database still were missing from the Physician Compare site. CMS has made updates about every month or so since December and appears to have added more entries, he said.

However, CMS draws the physician information for the comparison website from the Medicare Provider Enrollment, Chain, and Ownership System, known as PECOS. So a doctor with mistakes or missing information in his or her PECOS record will find the same mistakes on Physician Compare.

"Unlisted doctors occasionally have to go into their enrollment records to input information that was clearly provided to CMS previously, such as location and licensure," Peele said.

The second type of error involves health professionals who will appear in the listings but don't always show up when their locality is searched. For instance, one won't find optometrist Roger Jordan in Gillette, Wyo., when searching for optometrists in his ZIP code of 82716. The site says there are no optometrists in his specialty within 25 miles of his location. His listing is found after modifying the search to include individuals within 150 miles of the ZIP code. But Jordan's contact information is found lower down on the list than an optometrist who is 147.7 miles from the search location.

Searching for optometrists by typing "Gillette, Wyoming" or "Gillette, Wyo." gives the user an error message. But typing "Gillette, WY" allows the user to find Jordan, along with eight other optometrists within 15 miles of the city.

"I understand there might be an issue for someone who just updated the record, and certain changes won't be current at the moment," said Jordan, who has been in practice for 30 years. "But for someone who's had no changes for a bunch of years?"

The rest of Jordan's biographical information appears to be correct in the database, but he's heard from colleagues who have encountered similar accuracy problems.

At a disadvantage

McCraw, of the South Carolina orthopedics practice, believes physicians who have errors under their names or who don't appear on the site are disadvantaged because potential patients might not be able to connect with them.

"Until CMS determines how to accurately populate the Physician Compare website with the information that does already exist in PECOS, it should be pulled from the Web," she said.

CMS officials did not respond to requests for comment by this article's deadline. But on the day of the website's release, CMS Administrator Donald M. Berwick, MD, said the tool eventually would give patients the same reliable quality information on physicians that Medicare does for hospitals and nursing homes.

Physician Compare "moves us closer towards CMS' goal to improve the quality of health care for people with Medicare in all the places where they receive care, including the doctor's office," Dr. Berwick said. "By using a considered, step-wise approach to spotlighting quality of care, we can create a tool that will help doctors and patients for decades to come."

Physicians remain concerned that if CMS can't get relatively simple biographical information right, expanding the site by 2013 to include performance scores or other quality data might not result in a trustworthy resource for patients. The site says whether a physician successfully participated in the Medicare PQRS. But starting in 2013, CMS plans to include each participating physician's performance results in that program, based at first on the 2012 reporting year.

CMS held one forum with health industry organizations to discuss Physician Compare on Nov. 30, 2010, one month before the site went live. The AMA had asked CMS to allow physicians to review their information before it was published online, but the agency did not honor the request.

"The Physician Compare website must be designed so that accurate, valid and timely information is available to Medicare beneficiaries in a format that will enable them to make educated decisions about their health care needs," the AMA said in a statement delivered to CMS at the forum.

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If errors found, start with PECOS

Physicians are instructed to update Medicare enrollment information when they find mistakes on the Physician Compare website. Missing or incorrect information is probably caused by:

  • No enrollment record in the Provider Enrollment, Chain, and Ownership System (PECOS). Affected physicians need to submit enrollment applications.
  • A missing address in PECOS. Affected physicians need to update their addresses in the system.
  • Out-of-date or missing information regarding a specialty in PECOS. Affected physicians need to update their specialties in the system.

CMS provides links for physicians to submit these and other corrections (link).

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External links

Medicare Physician Compare search page (link)

CMS instructions on updating Physician Compare information (link)

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