Nursing Home Compare better than other government 'transparency tools' but has room for improvement, GAO finds

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Nursing homes to have first look at new quality-rating provisions today
Nursing homes to have first look at new quality-rating provisions today

Government websites are not especially good tools for helping consumers choose healthcare providers, but Nursing Home Compare is in some ways the best model so far, according to a report released Tuesday by the Government Accountability Office.

Among the problems identified by the GAO, “transparency tools” such as Nursing Home Compare and Hospital Compare do not contain information on how much services cost, are hard for consumers to comprehend, and they do not allow consumers to easily sort different providers based on selected criteria.

In terms of understandable information about quality, Nursing Home Compare does better than similar tools for hospitals, doctors, dialysis facilities and home healthcare. It is the only tool that summarizes providers' performance using easily understood symbols, through the five-star rating system. However, Nursing Home Compare is not “written in plain language with clear graphics” and offers very limited ability for consumers to customize the information they see, the report states. All the other transparency tools have similar problems, although the GAO authors determined that the home healthcare tool does use more consumer-friendly language and graphics.

Centers for Medicare & Medicaid Services officials told the GAO that cost information would be difficult to include because beneficiaries are enrolled in a variety of plans beyond traditional fee-for-service Medicare. However, CMS could estimate out-of-pocket payments for services and procedures based on provider reimbursement rates and cost-sharing in basic fee-for-service, the report asserts. This would at least provide a baseline for consumers, the authors argue.

CMS concurred with the recommendation to include cost information “to the extent feasible” on Compare websites. The agency concurred with the report's other recommendations as well, and noted that some improvements — such as expanding the five-star system to other provider types — already are in the works. However, CMS also noted budget constraints and other restrictions on how much action can be taken.

So far, development of the tools has been “heavily influenced” by providers, which have objected to such features as rankings of providers, the report states. To improve the tools, CMS needs to consider consumer needs more than the interests of providers, the authors conclude.