Physician Comment and Request for Information

The CPPI project strives to use the most current and best available data to help evaluate the quality and affordability of patient care.  As one step in assessing the measurement data completeness, we are sending physicians reports of their measure scores and inviting physicians to self-validate their results.

The data used in the CPPI initiative relies upon the most widely available data – claims records – to measure patient care quality.  The limitations of claims data are generally understood but this is an opportunity to better document the strengths and weaknesses of the information available in California today.  We are working to understand the extent of claims information limitations due to incomplete data submitted on claims records, inaccurate physician demographic information, and gaps in data due to the claims data capture systems.

CPPI is providing physicians the opportunity to obtain a list of the commercially insured patients who have been attributed to them and those patients’ quality results.  Please follow the process below to request and evaluate this information from Thomson Reuters, the CPPI information vendor:

Step 1: Sign and Return Request Form:

*** Physicians may request their commercial patient list only after receiving a Physician Performance Report.

Please download, print, complete, and sign the Request for Patient List and Appropriate Data Use Form and return it to Thomson Reuters by FAX: 805-681-5810, Attention Amanda Mummert or by mail to:

Amanda Mummert
Thomson Reuters
5425 Hollister Avenue, Suite 140
Santa Barbara, CA 93111

The last day to submit a request to Thomson Reuters is December 5, 2008. Incomplete forms will not be processed.

Step 2: Processing of Request:

Thomson Reuters will process received request forms within five business days of submission and mail or email the patient-level file to each requesting physician.  If the physician’s primary specialty as submitted by the physician in the Request for Patient List And Appropriate Data Use Form differs from the specialty listed in the CPPI records, it may impact attribution, and therefore, the measure scores.  Rather than generating a patient list, Thomson Reuters will notify the physician that their specialty designation will be corrected and their measure results voided.

Step 3: Additional submission of data by physician (if needed):

You will be able to evaluate and submit corrections to Thomson Reuters after you receive the list of patients.  The patient lists will include instructions to mail or email the corrections back to Thomson Reuters.  All submissions must be received by Thomson Reuters by January 16, 2009.

Step 4: Log of Data Correction Findings:

Thomson Reuters will log the physician submitted correction requests and tabulate the frequency and nature of corrections. Data corrections will be made to the physician’s aggregate performance data.

Step 5: Review of Data Correction Findings

Data correction findings will be summarized and reported to CCHRI to review with the CPPI Physician Advisory Group and the CPPI Steering Committee at the end of the Comment Period (January 30, 2009).  Pending these findings, the health plans will determine how they will use the data.

Summary of Timeline of Physician Comment and Request for Information Process:

» Return to CPPI index

Blue Shield of California announced that the health plan will launch its physician quality recognition program June 1, 2010. Network physician listings will include physician quality designations for a set of 8 CPPI quality measures. A set of physicians, who have sufficient patient samples to be reliably scored, have been designated as higher quality performing physicians for select preventive screening and chronic care measures. Blue Shield members can view this new information in the plan's online physician directory. See the Blue Shield announcement here.

Physicians in the Blue Shield network who would like to request a duplicate of the Physician Performance Report that you received last summer may request a copy here.

CPPI Project Communications
Julie France, PBGH
jfrance@pbgh.org