Suppose you or a loved one needed to get cardiac bypass surgery. Wouldn’t it be useful to be able to consult one online tool to find and evaluate a surgeon and hospital as well as a nursing home and home health services for rehabilitation after this surgery?
The Centers for Medicare & Medicaid Services is betting the answer is yes.
Last month, CMS unveiled Care Compare, a streamlined redesign of eight existing CMS healthcare compare tools available on Medicare.gov.
Care Compare aims to give Medicare patients and family caregivers a user-friendly online tool to make informed decisions about healthcare based on location, cost, quality of care, volume of services, and other data, and the site is compatible for use on smartphone and tablets.
Patients can find information in eight areas: doctors, hospitals, nursing homes, home health, dialysis centers, long-term care hospitals, inpatient rehabilitation and hospice groups.
“By aggregating all eight of CMS’ quality tools into a single interface, patients can easily research different providers and facilities before they entrust themselves to their care.” said CMS Administrator Seema Verma, in announcing the new tool. The goal, she said is “ensuring the tools are robust and beneficial to patients.”
The consolidation could also boost patient awareness.
Emma Boswell Dean, assistant professor of Health Management and Policy at University of Miami’s Miami Herbert Business School, said before Care Compare, the tools were somewhat underutilized separately. “In talking to Medicare patients, they don’t even know all the tools available. Bringing them together in one tool is a really smart idea.”
Still, Dean and other experts gave Care Compare mixed reviews. While all agreed the amount of information available is important and deep, some said the tool could be easier to manipulate for seniors, while others question aspects of the underlying data. However, they all noted that the tool itself will be constantly updated and improved upon and that CMS is welcoming feedback.
Let’s explore how the new tool can benefit consumers and what could be better.
How does the new Medicare Comparison tool work?
A consumer who goes to medicare.gov/care-compare will be asked to put in a ZIP Code or city, then use a drop-down menu to select the type of provider they are looking for and begin a search. The site allows someone to compare up to three providers side by side.
And while these provider tools were offered separately before, consumers who want to research and compare several different types of providers — say hospitals, rehabilitation services and nursing homes — can start and finish their searches on Care Compare, Verma said. Over time, CMS said it plans to more closely standardize the type of information that is provided among all of them, where possible.
How user friendly is Care Compare as a one-stop shop?
For its part, CMS’ Verma said Care Compare was designed to be user-friendly and optimized for use on desktops, laptops, tablets or phones. Enhancements for mobile use will give practical benefits like calling the provider simply by clicking on the provider’s phone number.
UM’s Dean believes Care Compare will be most useful when you don’t even know where to start. “In a lot of cases, certainly when I moved to Miami, you don’t know what the best healthcare providers are, you don’t know which hospitals you should be going to. Oftentimes, we depend on recommendations from friends or family members or other people in our community. But sometimes you might not know anyone who has, for instance, used a dialysis facility before,” said Dean.
The new interface is relatively straightforward, but some aspects of it could be even easier for its target demographic, Dean said. “So if you go to, for instance, hospitals, and you want to compare two different hospitals, you have to click the Compare button essentially three times. I don’t think my grandmother could figure that out,” said Dean.
The consumer would need to know what matters to them and have the time to dig through the information that’s available to find the nuggets to help them make informed choices, said Tricia Neuman, executive director of Kaiser Family Foundation’s Program on Medicare Policy.
Some of the comparison tools have more information than others and there are gaps. For example, she said there’s no feature that would allow somebody to find out which Medicare plans include a particular doctor in their networks. For that information people may need to bounce back and forth between Care Compare and Plan Finder one of CMS’ most popular tools.
What’s more, Medicare Advantage plans are popular in South Florida, and the Care Compare may have more providers listed than are in the Advantage networks, she said.
Patients or their family members are likely looking for this information during a medical crisis and they aren’t experts in this. Neuman recommends they should try to narrow down the features that matter the most to them. Then they can whittle down the providers in their area to find the ones that come closest to meeting their needs. Advocates with local nonprofit agencies for the aging can help seniors navigate this process, too, she said.
Is the information on Care Compare reliable?
While most of the information is reliable, the experts say, some could be improved or presented differently. For example, hospital star ratings on the Care Compare tool have drawn criticism, particularly by the hospitals.
Dean explained that the controversial hospital ratings are calculated using what’s called the latent variable model, which attempts to look at various correlations among factors like mortality rates, readmissions, patient safety and other variables to arrive at a quality rating. However, models of this type are complex and it’s difficult for hospitals with low ratings to know where they need to improve, Dean said.
CMS announced in August that it plans to change the methodology used for its hospital star ratings in early 2021 to a simple average of quality scores they collect across different measures. This change is intended to make it easier for hospitals to know what they need to improve and simpler for consumers to understand.
Until then, it is updating the ratings on Hospital Compare using the current methodology.
Dean suggests looking at other ratings services as well, such as Leapfrog Group’s, when evaluating providers. She also noted actual costs for the patient are not as transparent as they could be, such as facility fees.
CMS has said that in conjunction with Care Compare, additional improvements have been made to other CMS data tools to help Medicare beneficiaries compare costs. One such website is the Procedure Price Look Up, which now includes physician fees and facility fees, for a more accurate picture of the true out-of-pocket costs.
Much of Toby Edelman’s work revolves around nursing homes so she has used Nursing Home Compare a lot over the years.
Go to the Nursing Home section of Care Compare and you’ll find a lot of useful information, said Edelman, who is a senior policy attorney for the Center for Medicare Advocacy.
For example, the nursing home comparison section provides information including how the facility scored on health inspections, staffing, quality of resident care, number of certified beds, whether it accepts Medicare and Medicaid, whether it’s a for-profit or nonprofit facility, and whether the nursing home is located in a hospital complex.
And there is even more when you dig deeper, she said. For example, a big concern recently has been nursing homes’ improper use of antipsychotic drugs and you can find information about that on the site. Also, nursing homes with patient abuse violations are flagged with a prominent red icon on the first page the user sees as well as an explanation.
No data set is perfect, of course. But Edelman says part of her work involves reading about outcomes in nursing home cases, but “the most serious problems sometimes just never show up on Nursing Home Compare.”
Nursing staffing levels now based on claims data
Still, she says, CMS has made improvements, such as the nursing staffing indicators are now based on claims data rather than self-reported. The assumptions for proper staffing levels go back to reports two decades ago and more, and she notes that because of the trend of more people aging at home, the populations in nursing homes have gotten sicker. As a result, what is considered proper staffing today has changed.
The “quality” rating on Nursing Home Compare is based on what the facilities report from self-reported patient surveys, which can be biased because of the way the questions are presented. The result: A large portion of nursing homes come out with four and five stars in quality, Edelman says.
Issues with how Medicare rates nursing homes
CMS has made revisions over the year to address this, but the ratings still keep creeping up. The self-reported quality ratings are also used to determine a portion of the overall rating, which also encompasses ratings for health inspections and staffing levels. What’s more, these facilities often cite these “quality” scores in their marketing materials, Edelman said. “It’s very troubling.”
In a national study by University of Chicago and Harvard researchers released in December 2019 about how nursing homes self-report major injury fall rates, the researchers found the data on Nursing Home Compare to be underreported. Only 57.5% of residents’ major injury falls that were identified in Medicare hospital admissions claims data were reported on residents’ self-reported assessment data that goes into the quality rating.
Edelman wishes CMS would call the quality measure “resident assessment information” and not include the measure in the overall rating. The resident assessment information could still be available on Care Compare for anyone to access.
CMS is always evaluating feedback and making revisions as needed, “but they [CMS] stuck to their guns on the abuse icon,” Edelman said. “It looks like a stop sign and it is red, it gives you a clue something is going on here. The industry really wanted that changed and CMS did not back down. CMS is trying hard, they care, they are good people.”
What’s next for Medicare’s new compare tool?
CMS has said the agency will be evaluating feedback from users and providers and continuing to make improvements to the tool. An online survey pops up on Medicare.gov for users. For now, users will still be able to access the original eight compare tools while CMS continues to make updates and collect feedback.
More new Medicare tools
CMS also launched other tools that will be of interest to consumers who are choosing plans. These include:
▪ A redesigned Medicare Plan Finder tool with a webchat option.
▪ A “What’s Covered” app that tells people what’s covered and what’s not in Original Medicare.
▪ A price transparency tool that lets consumers compare Medicare payments and co-payments for certain procedures performed in both hospital outpatient departments and ambulatory surgical centers.
▪ Interactive online decision support to help people better understand and evaluate their Medicare coverage options and costs between Original Medicare and Medicare Advantage.
▪ An online service that lets people quickly see how different coverage choices will affect their estimated out-of-pocket costs.
Nancy Dahlberg is a freelance business writer and can be reached at [email protected] and @ndahlberg on Twitter.