Public Reporting Background

This section provides background information about the public reporting of performance information for Medicare doctors, clinicians, and groups.

• What is the history of publicly reporting performance information for doctors, clinicians, and groups?

• What is the statutory authority for publicly reporting information about Medicare doctors, clinicians, and groups?

What is the history of publicly reporting performance information for doctors, clinicians, and groups?

Consistent with the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) first started a phased approach to public reporting on Physician Compare, the predecessor website focused on public reporting for doctors and clinicians, beginning with the 2012 Physician Quality Reporting System (PQRS) performance information. CMS expanded the number and types of performance information available on Physician Compare. The Medicare and Chip Reauthorization Act (MACRA) of 2015 extended this authority. In 2019, the first Quality Payment Program (QPP) performance information (performance year 2017) was publicly reported on Physician Compare. In 2020, CMS transitioned to publicly reporting performance information on the Medicare.gov compare tool and the Provider Data Catalog (PDC). The most current performance information available for doctors, clinicians, groups, and Accountable Care Organizations (ACOs) is the 2021 performance year QPP performance information.

What is the statutory authority for publicly reporting information about Medicare doctors, clinicians, and groups?

Physician Compare and its successor website draw operating authority from Section 10331(a)(1) of the ACA. Under this authority, CMS developed Physician Compare and initiated a phased approach to public reporting. Section 1848(q)(9)(A) and (D) of MACRA facilitates the continuation of this phased approach for publicly reporting doctor and clinician performance information.

Section 1848(q)(9)(A) and (D) of the Social Security Act requires CMS to publicly report:

• Merit-based Incentive Payment System (MIPS) eligible clinicians’ final scores;
• MIPS eligible clinicians’ performance under each MIPS performance category;
• Names of eligible clinicians in Advanced Alternative Payment Models (APMs) and, to the extent feasible, the names and performance of such Advanced APMs; and
• Aggregate information on the MIPS, including the range of final scores and performance category scores for all MIPS eligible clinicians, periodically.