Making informed decisions about healthcare is crucial, and the Centers for Medicare & Medicaid Services (CMS) is committed to providing resources that empower patients and caregivers. The Medicare.gov compare tool is a vital service designed to offer transparent performance information for doctors, clinicians, groups, and Accountable Care Organizations (ACOs). This tool is an invaluable asset for anyone seeking to compare healthcare providers, understand quality metrics, and ultimately choose the right care.
Enhanced Transparency with Additional Procedures Data
In an ongoing effort to enhance transparency and provide patients with comprehensive information, CMS has expanded the data available on the Medicare.gov compare tool. Recently, CMS added new procedures to the utilization data, offering deeper insights into clinicians’ experiences. This update builds upon the initial procedure volume data released in January 2024, which included 12 key procedures such as hip and knee replacements, spinal fusion, cataract surgery, and colonoscopies.
Now, the July 2024 update broadens this list to encompass even more procedures, including:
- Upper endoscopy
- Arthroscopy – upper extremity
- Arthroscopy – lower extremity
- Varicose vein ablation
- Laminectomy/laminotomy (lumbar)
- Lower limb revascularization
This expanded data set reflects procedures performed for both Original Medicare and Medicare Advantage patients within the previous year, ensuring the information is timely and relevant. CMS plans to continue adding procedures to the Medicare.gov compare tool periodically, further enriching its value as a resource for informed healthcare decisions. For a detailed list of all procedures and more background information, refer to the “Utilization (Procedure Volume) Data Published on the Compare Tool on Medicare.gov July 2024” fact sheet. The current procedure volume data file is also accessible within the doctors and clinicians datasets.
2022 Quality Payment Program (QPP) Performance Data Now Available
Further enhancing its commitment to transparency, CMS has integrated the 2022 Quality Payment Program (QPP) performance information into the Medicare.gov compare tool. This update includes data for doctors, clinicians, groups, virtual groups, and ACOs, providing a comprehensive view of healthcare provider performance. This information is crucial for patients and caregivers looking to assess the quality of care offered by different providers.
The reported data includes MIPS final scores, performance across MIPS categories, and identification of clinicians participating in Advanced Alternative Payment Models (APMs). Performance is presented through easily understandable formats such as measure-level star ratings, percent performance scores, and checkmarks. By making this 2022 QPP performance data publicly accessible, CMS empowers Medicare beneficiaries to actively participate in their healthcare choices and select providers who best meet their needs.
Address Suppression for Telehealth and Non-Patient-Facing Services
Recognizing the evolving landscape of healthcare, particularly the rise of telehealth, CMS has implemented a feature to protect the privacy of doctors and clinicians. For those providing telehealth-only or non-patient-facing services from their homes, address suppression is now available on Medicare.gov compare tool profile pages.
Clinicians can designate their home address as a “Home office for administrative/telehealth use only” in the Provider Enrollment, Chain, and Ownership System (PECOS). This action will suppress street address details from public view. Alternatively, clinicians can contact the QPP Service Center to request address and/or phone number suppression. Importantly, even with suppression, city, state, and zip code information remains, ensuring clinicians are still searchable and their performance data is reported. This feature balances privacy concerns with the need for provider information accessibility.
Telehealth Indicator for Enhanced Access to Care
In line with the expansion of telemedicine services and CMS’s commitment to improving patient access to care, a new telehealth indicator has been added to doctor and clinician profiles on the Medicare.gov compare tool. This indicator simplifies the process for beneficiaries and caregivers to identify clinicians who offer telehealth services.
The telehealth indicator is a direct response to the increased demand for remote healthcare options and reflects CMS’s dedication to providing user-friendly tools that cater to patient preferences. This feature ensures that individuals seeking virtual care can easily find providers who offer these services, promoting greater convenience and access to healthcare. For further details, the “Telehealth Indicator on Medicare Care Compare: Doctors and Clinicians Public Reporting” fact sheet provides comprehensive information.
Expanded Facility Affiliation Information
The Medicare.gov compare tool has been further updated to include expanded facility affiliation information for doctors and clinicians. Beyond hospital affiliations, profile pages now incorporate affiliations with:
- Long-Term Care Hospitals (LTCHs)
- Skilled Nursing Facilities (SNFs)
- Inpatient Rehabilitation Facilities (IRFs)
- Home Health Agencies
- Hospices
- Dialysis Facilities
This enhancement creates a more connected and informative experience for users. By linking doctor and clinician profiles to specific facility profiles, patients and caregivers gain a broader understanding of a provider’s network and practice settings. This is particularly valuable for individuals requiring specialized care within different facility types. The facility affiliations are clearly displayed in a dedicated “Affiliations” section on profile pages, ensuring ease of access and navigation.
Expanded Archive for Doctors and Clinicians
For users seeking historical data, CMS has expanded the archive for doctors and clinicians within the Provider Data Catalog (PDC) on Medicare.gov. This expansion now provides access to historical Merit-based Incentive Payment System (MIPS) program performance data dating back to the program’s inception in 2017.
Previously, only one year of MIPS performance data was publicly available at a time. This update is beneficial for doctors, clinicians, researchers, and anyone interested in analyzing trends and historical performance data. Access to this expanded archive promotes data transparency and aligns reporting standards across different provider settings. Historical data can be accessed through the archive files.
Important Caution: CMS advises against making direct year-to-year performance comparisons using historical data due to changes in the MIPS program and public reporting standards. For detailed information and disclaimers, please refer to the “MIPS Data Archive on Care Compare: Doctors and Clinicians” fact sheet and disclaimer (135 KB) (PDF).
Medicare.gov Compare Tool: Advancing Health Equity
CMS is dedicated to ensuring equitable access to healthcare information. The Medicare.gov compare tool plays a crucial role in advancing health equity by making healthcare provider information accessible to all individuals. The tool supports access to care by providing information on payment amounts and telehealth availability, which is particularly beneficial for populations facing financial constraints, those in underserved areas, or individuals managing disabilities.
CMS employs a health equity-informed approach, utilizing plain language, user testing, and support for users without internet access. The availability of a separate Spanish-language site further enhances accessibility for diverse users. These efforts ensure that the Medicare.gov compare tool is a valuable resource for all individuals seeking to navigate their healthcare options effectively.
Need Assistance? Contact Us
For any questions regarding public reporting for doctors and clinicians on the Medicare.gov compare tool, the Quality Payment Program (QPP) Service Center is available to assist. Contact them via email at [email protected], through the QPP Service Center ticket system, or by phone at 1-866-288-8292 (Monday-Friday, 8 a.m. – 8 p.m. ET). For quicker assistance, especially during peak periods, consider calling before 10 a.m. or after 2 p.m. ET. Telecommunications Relay Services (TRS) are available for people who are deaf or hard of hearing by dialing 711. Stay updated on the latest news by subscribing to the QPP and Care Compare: Doctors and Clinicians listservs.
The Medicare.gov compare tool is continually evolving to meet the needs of patients and caregivers. By leveraging these resources, individuals can make informed healthcare decisions and access the right care, contributing to better health outcomes and a more equitable healthcare system.
