Making Medicare Make Sense

Q: I need a surgical procedure, and want to find the best hospital to have it done. Can Medicare help me and my doctor in this search process?

A: Yes, Medicare has lots of information available to help you. Of course, if you need emergency treatment, go to the hospital closest to you without delay. But if you need treatment that isn’t an emergency, you should take time to do some “homework” in advance.

First, talk to your doctor or health care provider, to find out which hospital(s) they work with. Ask him or her which hospitals will provide the best care for your needs – things like enough staffing, coordination of care, and patient safety.

Next, check your insurance coverage. Does the hospital participate in Medicare? Most do, but if you have a Medicare Advantage plan, be sure to check with the plan, as not all hospitals may be within the plan’s network.

By now, you may be considering just a few possible locations for your procedure, and this is where Medicare’s Hospital Compare tool can be a huge help for people with Original Medicare.

This easy-to-use part of the Medicare website can provide information about which hospitals have extensive experience in the procedure you are considering; which hospitals give recommended treatments for certain common conditions like heart failure, pneumonia, and surgery; and which hospitals have scored well in recent surveys of discharged patients. This means those who have actually been in that hospital rate how well the doctors and nurses communicate with them, and how well they manage the patient’s plan of care.

To use this tool, go to http://www.medicare.gov/hospitalcompare/search/aspx. Click on “Find and Compare Hospitals.” From there, you can enter a specific hospital name, or a location. For example, if you want to consider going to a hospital far from home, but near family members, you can compare hospitals in the distant city easily. You can do a general search, a search based on your medical condition, or a search based on a specific surgical procedure. You can compare up to three hospitals, side by side, to get a good look at their performance.

There may be other sources of information about hospital quality for you to use, as well. Some states require hospitals to report and post their results online, and these may differ from those on the Medicare website (for example, they may cover a different time period).

Together, these tools can help you learn about and understand the differences among the hospitals you may be considering, and help you make an informed decision about your health care.

If you have a question about Medicare, call 1-800-MEDICARE, which is, 1-800-633-4227. Medicare’s national toll-free helpline is available 24 hours a day, seven days a week, or visit http://www.medicare.gov for information and answers.