Clinician profile pages in the Medicare Care Compare tool now include certain procedure volume data to help patients and their caregivers choose a physician or health professional with relevant experience.
The Centers for Medicare & Medicaid Services (CMS) recently announced the change per the Medicare Access and CHIP Authorization Act of 2015, which mandates “information on items and services provided to Medicare patients by clinicians ... be made publicly available on an annual basis and in an easily understandable format.”
CMS has published the data in downloadable form since 2017 but hopes to make it more accessible by including comparative volume data on clinician profile pages.
“While the source of this data is useful to health care researchers and other interested parties who have the expertise to accurately interpret it, the technical nature of the information isn’t easily accessible or usable by patients,” a CMS fact sheet said of the prior format.
CMS began updating profile pages in January with data from the latest available one-year period across 12 procedures performed for traditional Medicare and Medicare Advantage patients. Patients will see a physician’s percentile rank for the number of procedures provided based on that data set. The procedures include:
- Hip replacement,
- Knee replacement,
- Spinal fusion,
- Cataract surgery,
- Colonoscopy,
- Open groin hernia repair,
- Minimally invasive hernia repair,
- Mastectomy,
- Coronary artery bypass graft,
- Pacemaker insertion or repair,
- Coronary angioplasty and stenting, and
- Prostate resection.
CMS will refresh the data periodically, accounting for a three-month claim-processing lag, and plans to add more procedures.
To access the data on a clinician profile page, go to the “Services” section and then to the “Procedures” category, which provides:
- The number of times the clinician performed the listed medical procedures for traditional Medicare and Medicare Advantage patients in the last available 12-month period; and
- An indication of where the clinician falls in the volume distribution (e.g., 78th percentile for performing a given procedure).
TMA experts advise physicians to check Medicare’s Care Compare tool to verify their information is correct. CMS typically notifies physicians annually and provides a window for updating their profile.
For more recent Medicare information, check out the Medicare 2024 Payment Update webinar CME, available in TMA’s Education Center.
Last Updated On
February 02, 2024
Originally Published On
February 02, 2024
Emma Freer
Associate Editor
(512) 370-1383