For almost two years now, those who help Medicare beneficiaries find plans have been using an updated Medicare Plan Finder, a tool that does not do all the things its predecessor, the Legacy Plan Finder, did. It appears the Centers for Medicare and Medicaid Services (CMS) decided it was time to work that same magic on Physician Compare.
The purpose of this website is to help beneficiaries with Original Medicare (Part A and Part B) find providers who accept Medicare assignment. That means the provider charges the Medicare-approved amount, so the beneficiary won’t be charged more than the deductible ($203 in 2021) and coinsurance (20% after deductible). (Medicare Advantage beneficiaries must use their plan’s tools to find providers in network.)
Since its inception, entering a ZIP code and a provider’s name or type of service, such as dermatology, would produce a list of providers who accept Medicare assignment.
Then, CMS updated Physician Compare to add clinician-level performance data to information already on the site, such as specialties and degrees. CMS wanted to provide beneficiaries with additional assistance in choosing high-quality clinicians.
However, it appears the website has not met this goal. Researchers say 99.7% of physicians’ profiles lack individual quality data and 77% lack group data. With the recent changes, Physician Compare doesn’t meet its primary purpose of helping beneficiaries find doctors who accept assignment.
Here’s an example. I used Physician Compare recently to help a client in southeast Florida find an orthopedic surgeon. I entered her ZIP code and was shocked by the findings. The first 10 items were the same surgeon. This was followed by a second, third and fourth surgeon from the same medical group, each listed 10 times. Every listing was unique because of one piece of information. For instance:
- A different address (street, city)
- A different suite number – 501, 504, 204
- A different phone number
- And most stunning, a different department, such as cancer, pathology, and neuroradiology but not orthopedics.
These same physicians appeared again several pages later; this time because the medical group was listed right after their names, instead of below the street address. The multiple listing issues were not limited to physicians from this medical group or Florida. There were many more physicians repeated multiple times, with various addresses and phone numbers. Searching other ZIP codes, I found the same problems.
I decided to track down information on the first surgeon. His website notes just one address and phone number. It’s possible someone could have found this doctor by calling any of the 10+ numbers in Physician Compare but it would no doubt have involved talking to multiple automated ladies and several transfers.
How did this happen and how can it be fixed?
This is just a guess, but the multiple entries may connect to how data get into the system. Twice a month, CMS pulls a data set from PECOS to update Physician Compare. (PECOS is the Medicare Provider Enrollment, Chain, and Ownership System that allows registered users to securely and electronically submit and manage Medicare enrollment.) When physicians are part of a medical group, they lose their individuality and are reassigned to the group. As a result, the group practice locations will be associated with that doctor.
CMS puts responsibility on the providers to make the necessary corrections. They must log into PECOS to review the group practice addresses and select their primary and secondary practice locations. If phone numbers or addresses are incorrect, the provider should send updates to the Physician Compare support team. These edits disappear in six months if the provider does not update PECOS to ensure correct information in the future. There is a similar multi-step process to update addresses and remove clinicians. Given the hustle and bustle of today’s medical practices, it’s probably difficult for anyone to sit down and make changes, particularly involving forty or more listings.
Not only have CMS’ efforts to add quality measures fallen short, but the tool makes it very difficult for beneficiaries to find healthcare providers who accept Medicare assignment, the primary reason for this site.