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CMS Releases Updated Quality Star Ratings for Hospitals

July 27, 2016
by Rajiv Leventhal
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Industry reaction to ratings system has not been positive thus far

After much anticipation, the Centers for Medicare & Medicaid Services (CMS) has finally published the first release of its overall hospital quality star ratings on the agency’s Hospital Compare website.

The overall hospital quality star ratings are designed to help individuals and caregivers compare hospitals in an understandable way. The star ratings currently in place, which were released last year, made public how hospitals rate on several quality measures, with a focus on the patient experience at Medicare-certified acute care hospitals. They specifically use data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) measures that are included in Hospital Compare. The site showcases 12 HCAHPS star ratings on Hospital Compare, one for each of the 11 publicly reported HCAHPS measures plus a summary star rating that combines or rolls up all the HCAHPS star ratings.

Now, the new overall hospital quality star ratings summarizes data from existing quality measures publicly reported on Hospital Compare into a single star rating for each hospital, aiming to make it easier for consumers to compare hospitals and interpret complex quality information. This overall rating, based on a composite score of one to five stars, with five being the best, supplements the star ratings currently posted for hospitals, based on the HCAHPS data.

In an announcement on July 27, CMS said that the methodology for the new overall hospital quality star rating was developed with significant input form a Technical Expert Panel (TEP) and refined after public input. The rating will include 64 of the more than 100 measures displayed on Hospital Compare. CMS collects the information on these measures through the Hospital Inpatient Quality Reporting (IQR) Program and Hospital Outpatient Quality Reporting (OQR) Program.

In a blog post accompanying the announcement, Kate Goodrich, M.D., director of center for clinical standards and quality at CMS, said “The rating includes quality measures for routine care that the average individual receives, such as care received when being treated for heart attacks and pneumonia, to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections. Specialized and cutting edge care that certain hospitals provide such as specialized cancer care, are not reflected in these quality ratings.”

Goodrich said that the agency has received numerous letters from national patient and consumer advocacy groups supporting the release of the ratings because it improves the transparency and accessibility of hospital quality information. She further noted research which found that hospitals with more stars on the Hospital Compare website have tended to have lower death and readmission rates.

She added that the delay of the release of the ratings from April was to give hospitals additional time to better understand our methodology and data. Goodrich said, “All of the measures used to calculate the Overall Hospital Quality Star Rating are based on clinical guidelines and have undergone a rigorous scientific review and testing. The vast majority are endorsed by the National Quality Forum. Most of these quality measures are already adjusted for clinical co-morbidities to account for the illness-burden of the population. Some hospitals have raised the question of making additional adjustments to account for the sociodemographic characteristics of the patients they serve.”

Indeed, earlier this year, the American Hospital Association (AHA) and other industry stakeholders wrote a letter to CMS pushing the agency to delay the release of the new ratings system. The AHA has long opposed the star ratings system, arguing that it doesn’t display an accurate portrayal of quality or patient experience. Despite the delay, in a July 27 statement, AHA said, “We are further disappointed that CMS moved forward with release of its star ratings, which clearly are not ready for prime time. As written, they fall short of meeting principles that the AHA has embraced for quality report cards and rating systems. We want to work with CMS and the Congress to fix the hospital star ratings so that it is helpful and useful to both patients and the hospitals that treat them.”

The Association of American Medical Colleges (AAMC) also released a statement ripping the government’s ratings, saying, “Patients should beware of making decisions about hospitals using the newly released star ratings. They are based on a deeply flawed methodology that does not take into account important differences in the patient populations and the complexity of conditions that teaching hospitals treat. As a result, many of the nation’s leading teaching hospitals—institutions that provide the most advanced healthcare in the world—have been assigned lower ratings than other hospitals that treat patients with less complex conditions or that treat only certain conditions. This new system could have very serious consequences for patients who are choosing where to go for treatment, potentially driving them away from some of the best hospitals for their conditions.”

The organization further took issue that hospitals are being measured on an equal basis, which should not be the case at all. It said that CMS used more than 60 measures to calculate ratings for teaching hospitals and as few as nine measures on some hospitals that treat patients with less complex conditions or that treat a limited number of conditions. AAMC also said that its analysis of the ratings “has confirmed that the lower the number of measures a hospital reported, the more likely a hospital was to receive a higher star rating. In fact, hospitals that reported on only 60 percent of the metrics or less received almost half of the five-star ratings.”

CMS will continue to analyze the star rating data and consider public feedback to make enhancements to the scoring methodology as needed. The star rating will be updated quarterly, and will incorporate new measures as they are publicly reported on the website as well as remove measures retired from the quality reporting programs, the agency said.

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