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DEPARTMENTS: Payment Strategies

“Care Compare” Empowers Medicare Beneficiaries to Select Health Care Facilities and Professionals

Schaum, Kathleen D. MS

Author Information
Advances in Skin & Wound Care: January 2021 - Volume 34 - Issue 1 - p 8-10
doi: 10.1097/01.ASW.0000724312.47932.f1
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Not only is this author a reimbursement strategy consultant and educator, but she is also a Medicare beneficiary. Like all 71.6 million “baby boomers” who are also Medicare beneficiaries, this author did not grow up with computers, tablets, and smartphones. Regardless, members of our generation are often described as independent and self-assured, competitive, goal-centric, team oriented, disciplined, resourceful, and having a strong work ethic. Therefore, we have embraced digital technology and learned to use it widely in our professional and personal lives for such purposes as managing our healthcare and choosing healthcare professionals, facilities, and treatment options.

Even with the Internet, Medicare beneficiaries often describe conducting healthcare-related research as a daunting task. Therefore, over 20 years ago, the CMS began developing websites where Medicare beneficiaries could identify and compare their healthcare options. By the time this new decade began, Medicare beneficiaries had access to eight available websites where they could compare how well facilities and physicians provided recommended care to their patients:

  1. Hospital Compare
  2. Home Health Compare
  3. Nursing Home Compare
  4. Hospice Compare
  5. Inpatient Rehabilitation Facility Compare
  6. Long-term Care Hospital Compare
  7. Physicians Compare
  8. Dialysis Facility Compare

Even though some older Medicare beneficiaries embrace digital technology, learning to navigate eight different healthcare comparison sites has proved to be very cumbersome, and utilization of these sites has not been as high as the CMS expected. For example, a Medicare beneficiary with a chronic ulcer may need to individually visit the Hospital Compare, Physician Compare, Nursing Home Compare, and Home Health Compare websites to research providers for the different phases of surgery and rehabilitation. Therefore, in September 2020 when the CMS announced the launch of a new healthcare comparison tool, this author, other baby boomers, and older Medicare beneficiaries were thankful and excited to use it.

The new digital tool, called Care Compare, combines the eight separate websites into one user-friendly tool that streamlines Medicare beneficiaries’ healthcare decision processes: they only need to use one tool to find and compare physicians and facilities that meet their specific healthcare needs. The new tool allows users to receive personalized data by filtering the items that are most important to them. It also provides complete contact information and directions to the physician offices and facilities. As an added benefit, Care Compare also works on mobile devices (eg, smartphones and tablets) in addition to desktop and laptop computers. In fact, if Medicare beneficiaries use their smartphones to conduct the comparisons, they can place a call to the selected provider by simply clicking on the provider’s phone number.

The new Care Compare tool can be accessed at www.medicare.gov/care-compare. With just one click, Medicare beneficiaries and caregivers can use the new tool to make healthcare decisions based on cost, quality of care, volume of services performed, and other data.

Let’s look at the type of comparison information that is available for four of the eight provider types: Table 1 displays the comparison information available about hospitals, Table 2 about home health agencies, Table 3 about nursing homes, and Table 4 about physicians. To view the many points of comparison and the information about the other four sites of care, this author recommends that you use Care Compare yourself. No doubt, you will be surprised about the volume of detailed information that is available for Medicare beneficiaries. In addition, you will find the information is quite easy to read and understand.

Table 1. - CARE COMPARE HOSPITAL INFORMATION
Comparison Information Tips and Guides
• Type of hospital
• Distance from home
• Overall star rating
• Patient survey rating
• Emergency services availability
• Participation in multispecialty surgical registry
• Ability to receive laboratory results electronically
• Ability to track patients’ laboratory results, tests, and referrals electronically between visits
• Timely and effective care measures
• Complications and mortality
• Unplanned hospital readmissions
• Psychiatric services
• Quality measures
• Payment and value of care
Steps to Choosing a Hospital, which lists questions to ask and items to consider before making a final selection
• Medicare coverage for inpatient hospital care
• Medicare coverage for outpatient hospital services
• Providers or suppliers who are terminated or are at risk for termination from Medicare
• Hospital survey inspection results
• Patients’ experiences of care at ambulatory surgical centers and hospital outpatient departments

Table 2. - CARE COMPARE HOME HEALTH INFORMATION
Comparison Information Tips and Guides
• Ownership type
• Quality rating, eg, managing daily activities, treating symptoms, preventing harm, preventing unplanned hospital care
• Patient survey rating
• Services offered eg, nursing care, physical therapy, occupational therapy, speech therapy, medical social services, and home health aides
• Next steps for choosing a home health agency
• Home health agency checklist
Medicare and Home Health Care booklet
• Medicare coverage for home health services
• Providers or suppliers who are terminated or are at risk for termination from Medicare
• How to file a complaint about your quality of care
• Helpful home health contacts

Table 3. - CARE COMPARE NURSING HOME INFORMATION
Comparison Information Tips and Guides
• Ownership type
• Located within a hospital
• Located in a continuing care retirement community
• Number of certified beds
• Participates in Medicare and Medicaid
• Automatic sprinkler systems in all required areas
• Overall rating
• Health inspections rating and detailed reports
• Staffing rating and number of hours per resident per day of licensed nurses, registered nurses, nurse aides, and physical therapists
• Quality of resident care rating (including number of short stay and long stay residents with pressure ulcers/injuries that are new or worsening)
• Existence of a resident and family council
• Fire safety and detailed fire safety inspection reports
• Checklist of questions to ask and things to consider when visiting a nursing home and/or skilled nursing facility
Guide to Choosing a Nursing Home booklet
• Alternatives to nursing homes
• Medicare coverage for nursing home and skilled nursing facility care
• Providers or suppliers who are terminated or are at risk for termination from Medicare
• List of nursing homes and skilled nursing facilities that have a history of poor care and may need increased oversight and enforcement
• Nursing home resident rights
• How to file a complaint and find state agency contacts
• Helpful websites and publications

Table 4. - CARE COMPARE PHYSICIAN INFORMATION
Comparison Information Tips and Guides
• Specialty
• Board certification(s)
• Education and training
• Place of residency
• Medicare participating provider
• Hospital affiliation(s)
• Group affiliation(s)
• Innovative model participant
• Electronic health record technology participant
• Medicare quality program participation
• Things to consider when choosing a physician and/or other qualified health professional
• Medicare coverage of physician and other qualified health professional services
• How to file a complaint about your quality of care
• How to find information about Medicare health plans
NOTE: Although most of the quality performance data on the Physician Compare website pertained to groups, rather than individual physicians, the CMS plans to report the 2018 Merit Incentive Payment System scores for Promoting Interoperability and Improvement Activities for both individuals and groups.

And there is more! After Medicare beneficiaries review the available comparison information, but before making their final selection, they can take advantage of the numerous tips and guides that the CMS has prepared for them. The tips and guides available for the provider/facility types reviewed are also included in Tables 1 to 4.

The original eight compare tools were active until December 1, 2020, and the CMS used the transition period to gather feedback and consider additional improvements to the Care Compare tool. The sunsetting of those other tools means Care Compare is now finalized and a unique, one-stop-shop option for Medicare beneficiaries.

SUMMARY

Right about now you may be wondering why this author chose to discuss the Care Compare tool in this Payment Strategies column. The answer is quite simple: to receive payment, healthcare facilities and physicians must first have customers (patients). As discussed at the beginning of this article, the baby boomers who are Medicare beneficiaries themselves and also managing the healthcare of their older family members have learned to use digital technology in many aspects of their lives, including selecting their physicians and healthcare facilities. The modernized Care Compare tool is now a “one-stop shop” for comparing location, quality, and price information about healthcare facilities and physicians.

Accordingly, facilities and professionals who provide wound/ulcer management services should take this opportunity to review their ratings and to compare their Care Compare ratings to those of their major competitors. If you have an “outstanding” rating, give kudos to your entire team, and encourage them to maintain that high level of service. If you do not, now is the time to engage your entire team in determining how you can improve the quality of your service. You may remember this old slogan: “A business without a sign is a sign of no business.” That slogan remains true today, but another saying may exceed it in importance: “A business with a poor rating has less or no business.” Now that Medicare beneficiaries can easily research different physicians and facilities using the comprehensive Care Compare tool, the future business success of facilities and physicians providing wound/ulcer management may depend on their published quality ratings.

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