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Experts break down the controversy over the agency’s release of Overall Hospital Quality Star Ratings.
Despite some pressure from hospital groups and other stakeholders to delay the reveal of the star ratings system for hospitals, CMS moved forward with releasing the Overall Hospital Quality Star Ratings.
The American Hospital Association said it was “disappointed” that CMS released the ratings, while others are calling for greater transparency of hospital quality.
“This is a first attempt and more an indication of the shape of things to come, rather than the definitive stars rating program,” says Nilesh Chandra, healthcare expert, PA Consulting Group. “CMS might have wanted to get the ball rolling on this before the election.”
The Overall Hospital Quality Star Rating combines 64 measures that are already public on Hospital Compare into one star rating. The measures fall into seven groups: mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care and efficient use of medical imaging. The patient experience of care hospital star ratings were first publicly reported in April 2015.
“A hospital's rating is only calculated using as many measures for which data is available,” says Managed Healthcare Executive editorial advisor Joel V. Brill, MD, chief medical officer, Predictive Health. “That means hospitals’ star ratings could be based on as few as nine measures or as many as 64; the average is roughly 40.”
According to Brill, if a hospital doesn't have data for three measures within at least three of the seven measure groups, including one outcome group-meaning mortality, safety or readmission-the hospital doesn't get a score. Currently, 937 hospitals do not have an overall star rating.
Star ratings will be updated each quarter. Currently, 102 hospitals have five stars, 934 have four stars, 1,770 have three stars, 723 have two stars and 133 have one star.
“One question is whether the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor,” Brill says. “The overall goal should be to improve the ratings, so that they are helpful and useful to both patients and the hospitals that treat them, and the plans that contract with them.”
The complaints regarding the rating system made by teaching hospitals and hospitals serving predominantly low-income populations have some legitimacy, according to Kev Coleman, head of research and data, HealthPocket.
“Both hospital categories have factors that can negatively affect key quality metrics such as hospital readmissions; teaching hospitals can attract more unusual and complicated patients due to their specialties and low-income hospitals serve populations with environmental and behavioral trends that can negatively affect health status,” Coleman says. “However, the lobbying to delay the release of the hospital rating data would have unnecessarily interfered with the positive contribution that the data will make presently to the public and researchers alike. With the ‘genie out of the bottle,’ teaching hospitals and low-income hospitals will now need to lobby for data collection and analysis adjustments that can accurately reflect the quality of care they deliver.”
Coleman believes that the release of the data in its present state will quickly be consumed by technology companies and then integrated into existing hospital evaluation web sites and mobile apps.
“As these sites and apps continue to build broader consumer adoption in coming years, we will begin to see signs of consumers migrating toward higher-quality healthcare providers when price and services are comparable,” he says.
Over the last few years, CMS has collected a lot of quality and outcomes data through its various quality reporting programs-the physician quality reporting system (PQRS), the qualified clinical data registry (QCDR), etc.-and this shows that CMS is finally putting all that data to use, according to Chandra.
“These ratings do not enable an apples-to-apples comparison, because the amount of data captured-and the quality measures vary widely both across specialties and based on the QCDR provider,” Chandra says. “However, over time, we will see a narrowing of criteria and using these quality measures will drive changes to clinician behavior that result in improved clinical outcomes at lower cost for all. If we consider the hospital stars ratings as a first step, rather than the final set of ratings; this program seems to be the right first step in the right direction.”
There is some concern over the Star Rating being too directly tied to the community, according to Jeff Cameron, healthcare expert, PA Consulting Group.
“For instance, services available in each community will result in higher ratings, and basically provide the affluent with the majority of the financial rewards,” Cameron says. “In essence the Star Rating is a system that promotes the rich getting richer and the poor staying poor. Therefore it stands to reason that a more affluent location has a much higher likelihood to have a CMS Star Rating above 4.0. If CMS put a community adjustment into the overall score, there would be a more accurate measurement that can be used for comparison.”
According to CMS, the Overall Hospital Quality Star Rating is designed to help individuals, their family members, and caregivers compare hospitals in an easily understandable way. Over the past 10 years, CMS has published information about the quality of care across the five different healthcare settings that most families encounter.