CMS Releases Overall Hospital Quality Star Ratings

Ken Terry

July 28, 2016

The Centers for Medicare & Medicaid Services (CMS) on Wednesday released overall hospital quality star ratings on the Hospital Compare website. While CMS already posts quality data on hospitals and other kinds of healthcare providers, this is the first time it has published the overall hospital ratings, which rank institutions on a scale of one to five stars.

"Today, we are updating the star ratings on the Hospital Compare website to help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side-by-side, and ask important questions about care quality when visiting a hospital or other health care provider," announced Kate Goodrich, MD, MHS, director of the CMS Center for Clinical Standards and Quality, in a post on the agency's blog.

Sixty-four of the 100 measures that CMS uses to report on hospital performance on Hospital Compare are incorporated into the overall star ratings. Key measures cited by CMS include postsurgical infection rates, length of emergency department waits, complication rates after hip surgery, readmission rates after heart attacks, and the likelihood of patients receiving multiple CT scans or MRI tests.

Hospitals are assessed only on the measures for which they submit data to CMS. Some measures, such as those related to deaths, readmissions, and use of medical imaging, include data from Medicare beneficiaries only. The patient experience, safety, and timely and effective care measures include data from any adult patient treated at hospitals.

The overall star ratings, which will be updated quarterly, apply to 4599 hospitals of all sizes and types. In the current rankings, 102 (2.2%) hospitals received five stars; 934 (20.3%), four stars; 1770 (38.5%), three stars; 723 (15.7%), two stars; and 133 (2.9%), one star. The remaining 937 facilities (20.4%) were not rated because they didn't report sufficient data.

Teaching hospitals, many of which treat poor and indigent patients, had an average ranking of 2.87 compared with 3.11 for nonteaching hospitals. Similarly, safety-net hospitals had a mean rating of 2.88 compared with 3.09 for nonsafety-net hospitals.

Dr Goodrich defended the methodology that CMS uses to risk-adjust the data for the severity of the cases treated at individual hospitals. The measures have undergone "rigorous scientific review and testing," she said, and "most of these quality measures are already adjusted for clinical co-morbidities to account for the illness burden of the population."

Some hospitals want CMS to make additional adjustments for the "socio-demographic characteristics" of their patients, Dr Goodrich noted. While CMS has not yet done that, she said, it is working with the National Quality Forum and the Assistant Secretary for Planning and Evaluation (ASPE) in the US Department of Health & Human Services "to study the effect of socioeconomic status on quality measures and payment programs based on measures." She left the door open for further risk adjustments should they prove warranted.

In general, she added, "CMS will continue to analyze the star rating data and consider public feedback to make enhancements to the score methodology as needed."

Negative Responses

The response from hospital associations to the overall star ratings was sharply negative. In a statement, American Hospital Association President Richard Pollack said, "The new CMS star ratings program is confusing for patients and families trying to choose the best hospital to meet their health care needs.… We are especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor."

Bruce Siegel, MD, president and Chief Executive Officer of Americas Essential Hospitals, the trade association of safety-net facilities, said in a news release, "The [overall star] ratings disadvantage hospitals that care for vulnerable patients and underserved communities and threaten to confuse, rather than inform, consumers as they make important health care decisions.… The star ratings exist partially in a black box, incorporate measures that miss clinically relevant data, and fail to adjust for patient circumstances that influence health and health care outcomes — circumstances outside a hospital's control."

Both associations referred to a bipartisan letter from 60 members of the US Senate and more than 225 members of the House of Representatives asking CMS to delay release of the star ratings until they could be improved. That letter prompted CMS to postpone the release of its overall star ratings from April to July.

In her blog post, Dr Goodrich said that CMS had received many letters from national patient and consumer advocacy groups that supported the release of the hospital ratings. She also pointed out that researchers had found that hospitals with more stars on the Hospital Compare website tended to have lower death and readmission rates.

 

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