The Centers for Medicare & Medicaid Services (CMS) is dedicated to enhancing transparency and providing beneficiaries with the information they need to make informed healthcare decisions. A key component of this commitment is the Medicare.gov Care Compare tool, a vital resource for comparing doctors, clinicians, and healthcare facilities. This article highlights recent updates and announcements concerning the Care Compare tool, ensuring you stay informed about the latest improvements designed to empower patients and caregivers.
Expanded Procedure Data for Doctors and Clinicians
In an ongoing effort to provide comprehensive information about clinicians’ experience, CMS has significantly expanded the procedure data available on the Medicare.gov care compare tool. Building upon the initial release of procedure volume data in January 2024, which included 12 common procedures such as hip and knee replacements, cataract surgery, and colonoscopies, CMS has added a further six procedures in July 2024.
The newly added procedures include upper endoscopy, arthroscopy for both upper and lower extremities, varicose vein ablation, lumbar laminectomy/laminotomy, and lower limb revascularization. This expansion means users can now access utilization data for a broader range of procedures performed by doctors and clinicians for Original Medicare and Medicare Advantage patients. This data reflects procedures carried out in the preceding 12 months, with a three-month claim processing period to ensure accuracy. CMS plans to continue adding more procedures to the Medicare.gov compare tool periodically, making it an increasingly valuable resource for patients seeking information about provider experience.
For a detailed list of all procedures and further background information, users can refer to the “Utilization (Procedure Volume) Data Published on the Compare Tool on Medicare.gov July 2024” fact sheet (PDF, 386.64 KB). The current procedure volume data file is also accessible within the doctors and clinicians datasets on the Provider Data Catalog.
2022 Quality Payment Program (QPP) Performance Data Now Available
Further enhancing the depth of information available, CMS has integrated the 2022 Quality Payment Program (QPP) performance data into the Medicare.gov care compare tool. This update encompasses performance information for doctors, clinicians, groups, virtual groups, and Accountable Care Organizations (ACOs). By publicly reporting 2022 QPP performance, CMS is fulfilling its requirement to share MIPS eligible clinicians’ final scores, performance under MIPS performance categories, and participation in Advanced Alternative Payment Models (APMs).
Performance data is presented in an accessible format, utilizing measure-level star ratings, percentage performance scores, and checkmarks, allowing Medicare beneficiaries and caregivers to easily assess and compare providers. This information empowers patients to choose the most suitable care and providers based on demonstrable performance metrics. Detailed information regarding the 2022 QPP performance data can be found on the clinician and group profile pages on the Medicare.gov compare tool and within the Provider Data Catalog (PDC).
Telehealth Indicator and Address Suppression for Enhanced Accessibility
Recognizing the increasing importance of telehealth, CMS has introduced a telehealth indicator on the Medicare.gov care compare tool. This new feature helps beneficiaries easily identify doctors and clinicians who offer telehealth services. The telehealth indicator is a direct response to the expanded use of telemedicine, particularly following the COVID-19 public health emergency, and underscores CMS’s commitment to adapting the compare tool to meet evolving patient needs.
In addition to telehealth enhancements, CMS is also addressing privacy concerns. Doctors and clinicians who primarily provide telehealth or non-patient-facing services from their homes now have the option to suppress their street addresses on their Medicare.gov care compare tool profile pages. This address suppression option allows clinicians to maintain their privacy while still being searchable by city, state, and zip code and having their performance information reported. Clinicians can designate their home address as a “Home office for administrative/telehealth use only” in the Provider Enrollment, Chain, and Ownership System (PECOS) or contact the QPP Service Center to request address suppression.
Expanded Facility Affiliation Information
To further improve the comprehensiveness of provider profiles, CMS has expanded the facility affiliation information on the Medicare.gov care compare tool. Beyond hospital affiliations, the tool now includes affiliations with Long-Term Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), Home Health Agencies, Hospices, and Dialysis Facilities.
This update offers patients and caregivers a more complete picture of a clinician’s practice, especially for those not affiliated with a hospital but working within other crucial healthcare settings. By creating linkages between clinician and facility profiles, the Medicare.gov compare tool facilitates a more interconnected and informative user experience. Facility affiliations are conveniently displayed in a dedicated “Affiliations” section on doctor and clinician profile pages.
Enhanced Data Transparency with Expanded Archive
CMS has significantly expanded the data archive within the Provider Data Catalog (PDC) on Medicare.gov, offering users access to historical Merit-based Incentive Payment System (MIPS) 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 archive expansion benefits researchers, clinicians, and other stakeholders seeking historical performance trends.
While this expanded archive provides valuable historical context, CMS cautions against direct year-to-year performance comparisons due to program and public reporting standard variations over time. Further details and disclaimers are available in the “MIPS Data Archive on Care Compare: Doctors and Clinicians” fact sheet and disclaimer (135 KB) (PDF). Users can access the archive files (ZIP) for in-depth historical data.
Commitment to Health Equity and Accessible Information
CMS is committed to ensuring that the Medicare.gov care compare tool promotes health equity by enhancing access to care for all beneficiaries. The tool is designed with features that support diverse users, including plain language, user testing, support for users without internet access, and a dedicated Spanish-language site. Information on payment amounts and telehealth availability is particularly valuable for populations facing financial barriers, those in underserved areas, or individuals managing disabilities. These considerations underscore CMS’s dedication to making healthcare information accessible to everyone.
Stay Connected and Get Support
For any questions regarding public reporting for doctors and clinicians on the Medicare.gov care compare tool, the Quality Payment Program (QPP) Service Center is available for support. Contact them via email at [email protected], through the QPP Service Center ticket system, or by phone at 1-866-288-8292. For timely updates, subscribe to the QPP and Care Compare: Doctors and Clinicians listservs.
By continuously updating and improving the Medicare.gov Care Compare tool, CMS is empowering Medicare beneficiaries with the information they need to navigate their healthcare journey effectively. Explore the Medicare.gov care compare tool today to discover these enhancements and find the right healthcare providers for your needs.
