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“Ask Phil, by UnitedHealthcare”: A Quick Guide to Medicare and Health Care Ratings Tools

Phil Moeller

Medicare is enormous – covering nearly 70 million current beneficiaries – and nearly everything about Medicare is measured. For every health care visit, exam or surgery that you’ve experienced, chances are it produced at least one piece of digital information.

Professionals have used this information for years to measure how Medicare works. Consumers have been much lighter users, but the growth of social media has dramatically expanded the reach of medical information and ratings. At the same time, it has turned consumer evaluations into a potent force that can shape the reputations and commercial fates of doctors, hospitals, and other care providers.

There is not enough time or space to list all the online sources of medical ratings. I have included references to more than 20 health care ratings resources, beginning with those tools produced by Medicare itself; providing some of the leading private ratings tools (often based on Medicare information); and then listing some of the major tools that use consumer experiences to evaluate health care providers.

Take these tools “for a spin.” It may take some time, but I can’t think of a more worthwhile cause. Finding the best health care possible may literally be a matter of life and death for you and your loved ones. Further, there almost certainly will be a lot of money riding on your decisions.

Before getting into specifics, here are some general rules you should follow:

1 – Don’t accept any ratings at face value, even those from Medicare itself. Who is producing and sponsoring the tool you’re using? How impartial are they? What are their objectives? Do you understand the data behind the tool?

2 – Don’t extrapolate a tool’s rating beyond the precise thing it is rating. A doctor who excels at one procedure may not necessarily be good at the procedure you need.

3 – Ratings sites that rely on consumer evaluations are prone to being manipulated by biased ratings. Use these ratings carefully and look for a site’s standards on how it filters incoming evaluations.

4 – Bigger is (usually) better. The more data taken into account by a tool (e.g. procedures performed, patients served), the more credible its ratings should be. Conversely, ratings based on small numbers may be suspect.

5 – While a “top” rating may draw your eye, the value of a rating rests within its individual components. A good ratings tool will clearly explain all that combines to produce a single rating, and provide access to the details you need to make an informed judgment.

6 – Ratings should complement and not replace the informed opinions of people you trust.
If my physician recommends a hospital, I will weight that heavily if I see negative ratings on the hospital. At the very least, I will go back to her and ask about any red flags that showed up in the hospital’s rating.

With these rules in mind, let’s begin with ratings provided by the Centers for Medicare & Medicaid Services (CMS). It oversees Medicare and is the source of most data that experts use in evaluating the health plans, hospitals, doctors, and other providers of health services used by Medicare enrollees.

The CMS Plan Finder tool lets you look at private Medicare insurance plans – Medicare Advantage plans (MA), MA plans with Part D drug plans bundled in (MAPD), and standalone Part D drug plans. CMS has developed a 5-star system to rate the quality of these plans.

You can compare up to three plans at one time using Plan Finder. The results page provides details on the Star Ratings for each plan, including its overall rating plus individual ratings on various parts of the plan. There are links to the data sources for each ratings component, so you can easily see all those details.

CMS produces many other ratings tools:

Physician Compare

Hospital Compare

Nursing Home Compare

Home Health Compare

Dialysis Facility Compare

Inpatient Rehabilitation Facility (IRF) Compare

Long-Term Care Hospital (LTCH) Compare

Hospice Compare

Many organizations use CMS data, often augmented with other information, to build their own tools. Some try to look for problems among doctors and hospitals providing services to Medicare beneficiaries.

For example, U.S. News & World Report provides health care ratings for doctors, hospitals, and nursing homes.

Here are some additional health care-related ratings tools:

Doctors

WebMD Physician Directory

Healthgrades Find a Doctor

RateMDs

Consumer Reports Heart Bypass Surgery Ratings

Hospitals

Consumer Reports Hospital ratings

Leapfrog Hospital Ratings

Healthgrades Top Hospitals

HealthInsight Top Hospital Rankings

HospitalInspections.org

Nursing Homes

HealthInsight National Nursing Home Rankings

Families for Better Care Nursing Home Report Cards

Every tool has its supporters and detractors, and fairly evaluating the quality of a medical product or services is very difficult. A doctor who specializes in high-risk surgeries might show poorly in terms of patient mortality. A good tool will adjust for the risk in that doctor’s practice, whereas a poor tool will not. The lesson here is to make sure you understand exactly what a tool is measuring.

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Journalist Phil Moeller is an expert on retirement and aging. He writes the “Ask Phil” column for the PBS NewsHour, is the author of “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs,” and is the co-author of the updated edition of The New York Times bestseller “How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” You can follow him on Twitter (@PhilMoeller) or reach him via e-mail: AskPhilByUHC@gmail.com.