Performance information for doctors & clinicians

Performance information like electronic health record technology participation, improvement activities, and star ratings can help you learn about the quality of healthcare a doctor, clinician, or group provides. Performance information comes from the Merit-based Incentive Payment System (MIPS), a Medicare initiative that provides doctors and clinicians with new tools and resources to help them give patients the best possible care.

Alternative Payment Models (APMs) aim to improve the quality and cost-efficiency of care for patients and populations. APMs can apply to aspects of care such as a specific condition, a care episode, or a population.

If a clinician or group participates in one or more Alternative Payment Models with Medicare, Care Compare displays the name of model(s) and a green check mark (Green Checkmark Icon) on their profile page.

While participation in an Alternative Payment Model with Medicare shows a commitment to quality care, it does not directly affect the way that patients pay the clinician or group.

The Electronic Health Record Technology performance category promotes the secure electronic exchange of information using certified electronic health record technology to encourage patient engagement and communication between clinicians.

If a clinician or group is a successful performer in the Electronic Health Record Technology performance category, a green check mark (Green Checkmark Icon) is displayed on their profile page with the following text:

Green Checkmark IconThis clinician or group is a successful performer in the Electronic Health Record Technology performance category.

If a clinician or group stated that they've restricted access to electronic health information, a caution sign () is displayed on their profile page with the following text:

This clinician or group knowingly limits patients' access to their own electronic health information, or restricts the exchange of electronic health information with their patients' other clinicians.

Clinicians and groups can also choose from many activities to demonstrate use of secure Electronic Health Record Technology. These Electronic Health Record activities are also displayed with green checkmarks (Green Checkmark Icon) on clinician and group profile pages.

Electronic Health Record Technology measures are publicly reported as star ratings on clinician and group profile pages so you can compare clinician and group scores to the best performers. Electronic Health Record Technology star ratings are based on a set of specific criteria and guidelines about demonstrating use of electronic health record technology.

Clinicians and groups can choose from many activities to demonstrate commitment to improving patient care. These Improvement Activities are displayed with green checkmarks (Green Checkmark Icon) on clinician and group profile pages. Up to ten activities are displayed.

Quality performance information shows how well clinicians and groups provide patients with the best recommended care.

A subset of clinician and group MIPS and qualified clinical data registry quality measures is publicly reported as star ratings on clinician and group profile pages. Star ratings show how well the clinician or group provided the recommended care to patients compared to the best performers for each measure.

The quality performance measures are divided into these categories:

• Preventive care: General health
• Preventive care: Cancer screening
• Patient safety
• Care planning
• Diabetes
• Cancer
• Heart disease
• Respiratory diseases
• Neurology
• Behavioral health
• Head, sinus, and ear care
• Eye care
• Orthopedics
• Immunology and infectious disease
• Gastrointestinal disease
• Referral and follow up
• Anesthesia care

Patient survey scores come from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS survey, which is specifically for groups caring for people with Medicare. The survey asks patients about their experiences with clinicians in the groups they visit for care. It covers important topics, like how well your clinician communicates.

You can use this information to learn about other patients' experiences with the group and to make more informed healthcare decisions. Groups that participate in this survey get performance scores based on the information their patients reported about them. Some groups have these performance scores on their profile page. Some groups are committed to providing high quality care but don't have patient survey scores.

The Doctors & Clinicians section includes information about doctors, clinicians, and groups who participate in the Quality Payment Program. This quality program participation and performance information is updated once a year.

Performance information, star ratings, and all data on the website are provided as a service to the public, and are not intended to grant rights or impose obligations. The assessment of performance included on these websites is limited in scope to the data sources used. A clinician's or group's performance on an individual measure or performance category may not be reflective of that clinician's overall quality of care.

At this time, not all clinicians and groups have performance information on Care Compare profile pages. If a clinician or group doesn't have performance information available, they can still be committed to giving high quality care. Only some of the information submitted to Medicare is currently available on the Care Compare profile pages. It's also important to understand that:

• Not all clinicians and groups submit the same information to Medicare, because not all clinicians provide the same services to patients. Also, not all services or types of care have measures available to submit to Medicare.
• Submitting more or less information is not a reflection of quality.
• The available performance information is not a complete picture of the types of services clinicians and groups provide. It is just a snapshot of some of the care clinicians and groups give to Medicare patients.