CMS Physician Compare - onetomapanalytics/Meta_Data GitHub Wiki

CMS - Centers for Medicare & Medicaid Services - Physician Compare

General description

  1. Database primary purpose - Provide useful information about physicians (e.g., location, specialty, education, spoken languages, and gender) and other healthcare professionals currently enrolled in Medicare
  2. Overall data type - Health providers
  3. Dataset type - Longitudinal
  4. Data source - Claims
  5. Data level - Physician level
  6. Geographic location of the data collection sites - United States
  7. Sponsor, manager, or home institution - Centers for Medicare & Medicaid Services
  8. Date range - 2014 - 2021
  9. Geolocation data - Organization address, city, state, zip code, phone number; the state where the clinician practices
  10. Dates - Graduation year
  11. Hospital identifiers - Medicare CCN (CMS Certification Number), PAC ID ("Provider associate level variable" - unique group ID assigned by Medicare Provider Enrollment, Chain, and Ownership System - PECOS), name
  12. Physician identifiers - NPI (National Provider Identifier), PAC ID (unique individual clinician ID assigned by PECOS), PECOS enrollment ID, and name
  13. Longitudinal tracking - Track providers (identifiers above)
  14. Financial variables - Whether clinicians accept Medicare-approved amount as payment in full, name of Alternative Payment Model (APM) with whom the individual eligible clinician participates, and cost category score (Merit-based Incentive Payment System "MIPS" variable)
  15. Clinical areas of interest - all
  16. Variables that are uniquely present in this dataset - CMS - Physician Compare contains six data files, including demographic data describing individual physicians or other clinicians (one file), clinician and group MIPS measures, and activities performance information (three files), clinician overall MIPS performance information, and clinician utilization data (one file).
  17. Database caveats and limitations - Information in the downloadable files does not exactly match the information as displayed on Care Compare profile pages since (1) a single clinician may have different specialties and different credentials from each enrollment; (2) the downloadable physician demographic database focuses on clinicians and their practice locations, there is no group level reporting in the downloadable demographic file; (3) only Medicare data (PECOS and claims) are used in the downloadable file, so all licensed data are excluded from this demographic dataset; (4) there is no board certification information; (5) there is no residency data; (6) there are more measures and activities represented in the downloadable files in the Provider Data Catalog (PDC) than on the Care Compare profile pages. To be included in the PDC, performance information must be statistically valid, reliable, and accurate; be comparable across collection types; and meet the minimum reliability threshold, as determined by statistical testing. To be included on Care Compare profile pages, performance information must also resonate with Medicare patients and caregivers, as determined by user testing. (7) there are clinicians in the Overall MIPS Performance file that do not have Care Compare profile pages or the National Downloadable File because they were assigned MIPS category and final scores but did not meet the requirements to be eligible for a profile or the National Downloadable File.

Applicable methods

  1. Association analysis, such as multivariate logistic regression (1, 2, 3), linear regression (4, 5, 6)
  2. Sensitivity analysis (7)

High-impact designs

  • Assess the quality of public reporting of U.S. physician performance (8)

  • Evaluate trends in general surgery practice consolidation (9)

  • Identify disparities in geographic access to medical specialties at the time of diagnosis (10)

  • Characterize specialty participation and performance in the MIPS (11)

  • Evaluate the association between financial incentives and physician practice participation in Medicare's Value-Based Reforms (12)

  • Evaluate the association of multiple hospital affiliations with clinician service use, breadth of procedures used, and costs (13)

  • Identify associations between provider-level variations and treatment planning (2)

  • Enrichment of the bank through linkage with another dataset, such as CMS - Hospital Compare (5), Consumer Assessment of Healthcare Providers and Systems (CAHPS) (14), the Drug Addiction Treatment Act buprenorphine-waived clinician list (15)

Data dictionary

To access the data dictionary, click here

Variable categories

  1. Medical credentials (e.g., credential, clinician's medical school, graduation year, medical specialty)
  2. Medical practice (e.g., organization name and ID, number of members)
  3. Merit-based Incentive Payment System (MIPS) performance (e.g., measure or attestation title, measure performance rate, quality category score)

Linkage to other datasets