§1395w–5 — Title 42 The Public Health and Welfare | U.S. Code

Summary

Create a Physician Compare website by January 1, 2011 that lists physicians in Medicare and other eligible professionals who take part in the Physician Quality Reporting Initiative. By January 1, 2013, for reporting periods starting no earlier than January 1, 2012, the Secretary must put a plan in place so the website shows comparable information on physician performance and patient experience. Where valid measures exist, the site must include things like quality-reporting measures, patient health outcomes and function, care coordination and episodes of care with risk‑adjusted resource use, efficiency, patient experience and engagement, and safety/effectiveness/timeliness, plus other appropriate information. The plan must use statistically valid data and risk adjustment, let doctors review their results before they go public, aim to give an accurate picture of performance, include care from other payers when practical, correctly attribute care among multiple providers, give timely feedback to clinicians, and use CMS computer systems that support reliable public reporting. The Secretary must protect individually identifiable health information from improper disclosure. The Secretary must consider input from multi‑stakeholder groups and may consider transitioning to value‑based purchasing. By January 1, 2015, the Secretary must report to Congress on the website, data collection plans, and recommendations. The Secretary may expand the website earlier. By January 1, 2019, the Secretary may run a demonstration offering financial incentives to Medicare beneficiaries who get care from high‑quality doctors, but beneficiaries cannot be charged higher premiums or cost sharing or lose benefits, and the program must not harm those with limited access or create unfair financial differences. One-line definitions: eligible professional — the type of clinician in the quality reporting program; physician — the Medicare definition of a doctor; Physician Compare — the website; Secretary — the Secretary of Health and Human Services.

Title 42, §1395w–5

The Public Health and Welfare — Source: USLM XML via OLRC

(a)(1)Not later than January 1, 2011, the Secretary shall develop a Physician Compare Internet website with information on physicians enrolled in the Medicare program under section 1866(j) of the Social Security Act (42 U.S.C. 1395cc(j)) and other eligible professionals who participate in the Physician Quality Reporting Initiative under section 1848 of such Act (42 U.S.C. 1395w–4).

(2)Not later than January 1, 2013, and with respect to reporting periods that begin no earlier than January 1, 2012, the Secretary shall also implement a plan for making publicly available through Physician Compare, consistent with subsection (c), information on physician performance that provides comparable information for the public on quality and patient experience measures with respect to physicians enrolled in the Medicare program under such section 1866(j). To the extent scientifically sound measures that are developed consistent with the requirements of this section are available, such information, to the extent practicable, shall include—

(A)measures collected under the Physician Quality Reporting Initiative;

(B)an assessment of patient health outcomes and the functional status of patients;

(C)an assessment of the continuity and coordination of care and care transitions, including episodes of care and risk-adjusted resource use;

(D)an assessment of efficiency;

(E)an assessment of patient experience and patient, caregiver, and family engagement;

(F)an assessment of the safety, effectiveness, and timeliness of care; and

(G)other information as determined appropriate by the Secretary.

(b)In developing and implementing the plan described in subsection (a)(2), the Secretary shall, to the extent practicable, include—

(1)processes to assure that data made public, either by the Centers for Medicare & Medicaid Services or by other entities, is statistically valid and reliable, including risk adjustment mechanisms used by the Secretary;

(2)processes by which a physician or other eligible professional whose performance on measures is being publicly reported has a reasonable opportunity, as determined by the Secretary, to review his or her individual results before they are made public;

(3)processes by the Secretary to assure that the implementation of the plan and the data made available on Physician Compare provide a robust and accurate portrayal of a physician’s performance;

(4)data that reflects the care provided to all patients seen by physicians, under both the Medicare program and, to the extent practicable, other payers, to the extent such information would provide a more accurate portrayal of physician performance;

(5)processes to ensure appropriate attribution of care when multiple physicians and other providers are involved in the care of a patient;

(6)processes to ensure timely statistical performance feedback is provided to physicians concerning the data reported under any program subject to public reporting under this section; and

(7)implementation of computer and data systems of the Centers for Medicare & Medicaid Services that support valid, reliable, and accurate public reporting activities authorized under this section.

(c)The Secretary shall ensure that information on physician performance and patient experience is not disclosed under this section in a manner that violates section 11 So in original. Probably should be “section”. 552 or 552a of title 5 with regard to the privacy of individually identifiable health information.

(d)The Secretary shall take into consideration input provided by multi-stakeholder groups, consistent with section 1890(b)(7) and 1890A of the Social Security Act [42 U.S.C. 1395aaa(b)(7), 1395aaa–1], as added by section 3014 of this Act, in selecting quality measures for use under this section.

(e)In developing the plan under this 22 So in original. The word “this” probably should not appear. subsection (a)(2), the Secretary shall, as the Secretary determines appropriate, consider the plan to transition to a value-based purchasing program for physicians and other practitioners developed under section 131 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110–275).

(f)Not later than January 1, 2015, the Secretary shall submit to Congress a report on the Physician Compare Internet website developed under subsection (a)(1). Such report shall include information on the efforts of and plans made by the Secretary to collect and publish data on physician quality and efficiency and on patient experience of care in support of value-based purchasing and consumer choice, together with recommendations for such legislation and administrative action as the Secretary determines appropriate.

(g)At any time before the date on which the report is submitted under subsection (f), the Secretary may expand (including expansion to other providers of services and suppliers under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.]) the information made available on such website.

(h)The Secretary may establish a demonstration program, not later than January 1, 2019, to provide financial incentives to Medicare beneficiaries who are furnished services by high quality physicians, as determined by the Secretary based on factors in subparagraphs (A) through (G) of subsection (a)(2). In no case may Medicare beneficiaries be required to pay increased premiums or cost sharing or be subject to a reduction in benefits under title XVIII of the Social Security Act as a result of such demonstration program. The Secretary shall ensure that any such demonstration program does not disadvantage those beneficiaries without reasonable access to high performing physicians or create financial inequities under such title.

(i)In this section:

(1)The term “eligible professional” has the meaning given that term for purposes of the Physician Quality Reporting Initiative under section 1848 of the Social Security Act (42 U.S.C. 1395w–4).

(2)The term “physician” has the meaning given that term in section 1861(r) of such Act (42 U.S.C. 1395x(r)).

(3)The term “Physician Compare” means the Internet website developed under subsection (a)(1).

(4)The term “Secretary” means the Secretary of Health and Human Services.

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 3014 of this Act, referred to in subsec. (d), is section 3014 of Pub. L. 111–148 which enacted section 1395aaa–1 of this title and amended section 1395aaa of this title. section 131 of the Medicare Improvements for Patients and Providers Act of 2008, referred to in subsec. (e), is section 131 of Pub. L. 110–275, 122 Stat. 2520, which amended section 1395w–4 of this title, enacted provisions set out as notes under section 1395w–4 of this title, and redesignated provisions formerly set out as a note under section 1395w–4 of this title as section 1395w–4(m). The Social Security Act, referred to in subsecs. (g) and (h), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Title XVIII of the Act is classified generally to this subchapter. For complete classification of this Act to the Code, see section 1305 of this title and Tables. Codification Section was enacted as part of the Patient Protection and Affordable Care Act, and not as part of the Social Security Act which comprises this chapter.

§1395w–5 Public reporting of performance information

Summary

Title 42, §1395w–5

Notes & Related Subsidiaries

Editorial Notes

References in Text

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