By Anna Szilagyi, Outreach & Program Development Coordinator, Medicare Rights Center
In September 2020, the Centers for Medicare and Medicaid Services (CMS) launched Care Compare, a redesign of their previous health care compare sites on Medicare.gov. Care Compare streamlines eight separate sites into one tool that allows Medicare beneficiaries to compare doctors and clinicians, hospitals, nursing homes, home health services, hospice care, inpatient rehabilitation facilities, long-term care hospitals, and dialysis facilities.
New York State announced a similar project for 2020. The goal of NYHealthcareCompare is to help New Yorkers compare the cost and quality of health care procedures at hospitals and access educational resources designed to help consumers know their rights, including financial assistance options and what to do about a surprise bill. Medicare enrollees may not have the same need to compare provider prices (except for non-covered services such as dental) as those with other types of insurance, but they do have the same problems with receiving confusing medical bills, being improperly billed, identifying in-network managed care providers, making informed decisions about their care, and finding providers with the highest safety ratings. CMS’s redesign of Medicare’s compare tool can offer direction to New York State in its design of a consumer health care compare site aimed at increasing health care transparency.
At medicare.gov/care-compare, Medicare beneficiaries and their families and caregivers can search by zip code, provider type, and optional keywords to get information on providers and compare up to three at a time. Once someone has started a search, Care Compare includes a list view and a map view (excluding for home health and hospice providers). The one-stop Care Compare tool is easier to navigate than using a different site for each type of provider, and the tool includes descriptions of each provider type to assist consumers with their searches. Care Compare’s design is a significant improvement from Medicare’s previous provider compare tools. However, not all provider information is relevant to consumers, and information that is relevant is lacking in certain areas.
When searching for doctors and clinicians, beyond basic contact and specialty information, consumers can see whether a provider is “participating,” which is important in estimating their Medicare cost-sharing. Participating providers accept Medicare’s approved amount for health care services as full payment and cannot charge beneficiaries more for Medicare-covered services. However, consumers enrolled in Medicare Advantage Plans would still need to confirm whether a provider is in network for their specific plan to ensure the most affordable care. Additionally, not all doctors and clinicians listed have performance information available, which makes it difficult to accurately compare providers.
Similarly, when comparing nursing homes, the tool shows how many fines or citations the facility has for fire safety and inspections. However, if the nursing home has not had an inspection, then the facility does not appear to have any quality issues. The importance of consistency and transparency is particularly important when comparing nursing homes.
Fortunately, Care Compare does include educational information for consumers in the compare view. Below the side-by-side comparison of providers, the tool includes next steps and key questions to ask before visiting a provider or receiving a health care service or procedure. For instance, when comparing hospitals, the tool links to the Medicare resources “Steps to choosing a hospital,” “How Medicare covers inpatient hospital care,” and “How Medicare covers outpatient hospital care” to help consumers make more informed health care decisions. This is also an opportunity to increase education and access to resources in New York State, such as financial assistance programs and consumer assistance programs.
While working to increase health care transparency for consumers, user-friendly tools with meaningful and relevant information are critical. In creating and updating a health care compare tool for New Yorkers, New York State should meaningfully engage consumers to identify what information and features are valuable to them. Consumer testing and focus groups could help inform NYHealthcareCompare and ensure the site is responsive to consumers’ needs.
While building out NYHealthcareCompare, New York State should consider including:
- Consistent and comprehensive quality measures to facilitate fair comparisons across health care providers. These measures should be clearly defined, so consumers understand how quality is assessed.
- Streamlined information that is relevant and comprehensible to consumers, such as insurance plans a provider accepts.
- Educational resources on questions consumers should ask before visiting a provider or receiving a health care service or procedure.
- Information to redirect people with Medicare to the Care Compare tool for comparing health care providers.
- Information on how to access financial assistance programs.
- Promotion of consumer assistance programs to help people navigate health care options and costs.
- A portal for consumer feedback and comments to inform updates to the site.
- Clear accessibility information, such as options to view content in different languages and larger type.