June 24, 2015
On May 29, 2015, approximately 18,000 physicians in California were notified of a new quality rating program through the California Healthcare Performance Initiative System (CHPI). CHPI is managed by staff from the Pacific Business Group on Health (PBGH), but has its own board of directors.
The letter states that 19 quality measures were constructed using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and United Healthcare. This claims data includes both commercial and self-funded health plan data from HMO, PPO, POS and Medicare Advantage products.
Along with the letter, CHPI provided affected physicians with their individual quality measurement scores based on patient care provided January 1, 2010, through December 31, 2012. Physicians were assigned a star rating of one to four stars, based on where they fall as a percentile within a “peer group,” for each measure as well as a rate, which is the composite score. The peer groups utilized for comparison purposes were:
- Primary care physicians (PCP)
- Non-PCP and non-pediatricians, regardless of specialty
Physicians who wish to verify the accuracy of the data used to calculate their scores can do so through the CHPI online portal. In order to access the review and correction portal, physicians will need their medical license number and the physician identifier (Physician ID) from the upper left corner of their mailed report. According to the letter, CHPI will treat the data as complete and accurate even if the physician has not logged into the online portal during the review and correction period. In response to California Medical Association (CMA) requests, however, CHPI will no longer deem non-review during this period as a physician’s acknowledgement that the data is accurate and complete.
Physicians who review their data and identify errors have until July 31, 2015, to report any discrepancies via the CHPI online portal. At the close of the physician review and correction period, discrepancies will be evaluated and applied, with the results recalculated prior to the ratings being released to the public. After July 31, the review and correction period will close, and physicians will be unable to review or report discrepancies.
CHPI has advised CMA that in addition to publishing the ratings publicly, it will also release an aggregated data file to the aforementioned participating plans following the recalculation this fall. CMA inquired as to how the data would be utilized by the plans, but as of the time of publication, it was not known.
More information on the CHPI ratings methodology can be found on the CHPI website. Additionally, physicians who did not receive a letter but would like to confirm whether they are included in CHPI’s rating results can use the CHPI physician lookup at https://lookup.medinsight.milliman.com and enter their medical license number. A tutorial and FAQ on the review and corrections portal is also available.
If you have questions or concerns about the CHPI rating results, you may email the PBGH staff overseeing the program at firstname.lastname@example.org or leave a voicemail at (415) 615-6353 and they will respond within 48 hours. Physicians who do not hear back within 48 hours or who identify a high volume of discrepancies in the data used to calculate their scores are encouraged to contact CMA at (916) 551-2061 or email@example.com.