With many seniors facing high medical bills, a congressional investigation has found that federal government websites meant to give Medicare patients basic consumer tools instead fail to provide adequate information on out-of-pocket costs, and even quality of care.
The nonpartisan Government Accountability Office found that Medicare lacks clear procedures for getting useful information to consumers.
The report, obtained by The Associated Press before its public release, finds "critical weaknesses" in five consumer-information websites run by the Centers for Medicare and Medicaid Services that seek to inform how well hospitals, nursing homes, physicians and other Medicare providers are doing.
The GAO said a confusing layout, data gaps and lack of customized information make it virtually impossible for consumers to get the information they need and won't be fixed anytime soon, even as the federal government plans new websites on the quality of hospice, inpatient rehabilitation and long-term care.
It is the latest report to detail problems in the government's health care websites. The Obama administration has already grappled with the technology meltdown experienced last year by HealthCare.gov as well as glitches in the Sept. 30 rollout of data on payments doctors receive from drug companies.
"The GAO report reveals that there is a need to empower patients with better information on health care price and quality," said Sen. Pat Toomey of Pennsylvania, home to the nation's fourth-largest share of residents 65 and older, at roughly 1 in 7. Only Florida, West Virginia and Maine have higher percentages of seniors.
"Armed with the facts, it will be possible for consumers to obtain high quality care and drive down costs," he said.
The GAO cautioned that due to a lack of clear policies or performance measures, CMS will likely continue to have "limited effectiveness in conveying relevant and understandable information on cost and quality to consumers."
It cited a growing need for the information due to rising health care costs.
Jim Esquea, an assistant secretary at the Health and Human Services Department, concurred with the recommendations. He wrote that CMS, an agency of HHS, was planning to expand its star ratings, already in use on its "Nursing Home Compare" website.
He also said HHS was committed to providing detail on estimated out-of-pocket costs "to the extent feasible" and had developed many internal procedures, although GAO said it had found no evidence that was the case.
In the study, GAO compared data on CMS' websites with that of third-party vendors providing similar information on gallbladder surgery, magnetic resonance imaging, or MRIs, of the lower back and maternity care. They also examined documents and interviewed company and government officials and experts on best practices.
In all, the audit found wide variation in charges for the same medical procedures in the same geographic area regardless of quality — information it said was not readily available on the CMS sites. Esquea said there were challenges in providing cost information.
In addition, the CMS sites often lacked critical data on quality of care, such as patient-reported outcomes on common procedures such as a colonoscopy, according to the report. In interviews with the GAO, CMS officials said they plan to add patient-reported outcomes on a number of medical procedures.
The investigators cited a likelihood of continuing problems despite the government's 2011 pledge under the Affordable Care Act to provide consumers complete and understandable information. While CMS has said it will make improvements, GAO pointed to limitations due in part to resistance from medical providers.
In recent months, the American Medical Association has opposed Medicare's release of billing records for 880,000 physicians, citing the danger of data being reported inaccurately or taken out of context; much of that information was eventually released.
"People deserve to know information on the cost and quality of the health care services they need," said Sen. Jeanne Shaheen, D-N.H., one of the lawmakers who requested the report. "The new GAO study makes important recommendations on how to better empower consumers, and I look forward to working with this bipartisan group of senators to establish more transparency."
