It was easy to feel a bit sorry for the Centers for Medicare & Medicaid Services Wednesday. They've got a big and likely acrimonious job ahead of them.
They've been charged by the Affordable Care Act to create PhysicianCompare.hhs.gov by January 1—only 64 days away—and make it even better than HospitalCompare.hhs.gov.
Then, not later than Jan. 1, 2013, for reporting periods to begin no sooner than Jan. 1, 2012, the agency must post information on quality, performance and patient experience for physicians enrolled in the Medicare program on a public website.
The smart people at CMS will have to figure out how to fill this site—an adaptation of Medicare's current Physician Finder not just with information about doctors that patients can use to make smart decisions about where to get care. They also must make the data useful for providers to improve upon that care.
They'll have to figure this all out and propose a rule that tries to satisfy everyone—or maybe not everyone and suffer the political slings and arrows —and put it into play in a dry run before next fall in a way that is "statistically valid and reliable," risk adjusted, "robust and accurate," the legislation directs.
On Wednesday, the agency took the bull by the horns and held a five-hour-long Town Hall to ask doctors, hospitals, employers and anyone else: What information, exactly should the website contain?
They heard an earful.
"We realize this creates quite a few more issues than other (website) settings may not have, and we know there's a lot of interest and opportunity but also some anxiety about it as well and how it will come out," acknowledged Michael T. Rapp M.D., CMS' director of quality measurement and health assessment.
Physicians' sex, race, languages spoken, office hours, medical school degrees and board certifications, age, hospitals where they have staff privileges and for how many years were just a few things many people said should be posted. To which health plan networks do they belong and are they still accepting new patients?
Have they won honors or awards, and do they devote time to caring for the poor?
And what about what quality measures? A recurring theme among some of the Town Hall speakers was whether the information to be posted will be adequately risk-adjusted for doctors who treat sicker patients, so they won't look worse than their colleagues who treat comparatively healthier patients. Do scientists today have enough confidence that the formulas are fair?