Amid pushback from providers, CMS on Wednesday released its first-ever overall hospital quality star ratings on Medicare's Hospital Compare website.
The agency originally planned to release the overall hospital quality star ratings in April. However, CMS delayed the ratings' publication in response to providers' and lawmakers' concerns about the ratings' methodology.
Methodology
The overall star rating is based off of 64 quality measures from seven categories: mortality, safety of care, readmissions, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging. Hospitals reported the data to CMS through the Hospital Inpatient Quality Reporting Program and the Hospital Outpatient Quality Reporting Program. CMS then used a clustering algorithm to assign hospitals a star rating on a one-to-five scale.
Only hospitals that have reported at least three measures within at least three categories, including one outcome group, are eligible for an overall rating.
Patients can see the ratings when they search for hospitals on the Hospital Compare website.
Screenshot of overall hospital star rating
When users scroll over the information symbol near the overall rating, they see a disclaimer that states the rating is based on "common conditions that hospitals treat" and may not reflect hospital performance on more complex conditions. The disclaimer advises patients to "discuss the results of the overall ratings with [their] physician or health care provider to determine the right hospital for [their] care."
According to CMS, the new "overall rating supplements the star ratings currently posted for hospitals" based on patient experience survey data. CMS has posted patient survey summary star ratings since April 2015.
Hospital performance
Out of 3,662 hospitals eligible for a rating:
- 102 hospitals earned a five-star rating;
- 934 hospitals earned a four-star rating;
- 1,770 hospitals earned a three-star rating;
- 723 hospitals earned a two-star rating; and
- 133 hospitals earned a one-star rating.
CMS did not assign star ratings to 937 hospitals because they "did not meet the minimum measure/group reporting thresholds."
Few of the nation's best hospitals—as rated by sources such as U.S. News & World Report—received five stars, according to Kaiser Health News. Instead, many relatively obscure or highly specialized hospitals received the top ratings. A preliminary analysis by Medicare also found that teaching hospitals and hospitals with large numbers of low-income patients tended to score lower.
Comments
Some industry groups criticized CMS for not further delaying the ratings. In a statement, American Hospital Association (AHA) President Richard Pollack said AHA was "disappointed" that CMS decided to release the ratings, warning that the methodology was over-simplified and could "unfairly penaliz[e] teaching hospitals and those serving higher numbers of the poor."
Federation of American Hospitals President and CEO Chip Kahn said in a statement, "The new hospital star ratings fall short and are not ready for primetime." He said the methodology for the overall star ratings "does not recognize the often significant differences between large and small hospitals, teaching and non-teaching, and those hospitals providing care in underprivileged areas."
Kate Goodrich, director of the Center for Clinical Standards and Quality at CMS, in a blog post wrote that the agency "received numerous letters from national patient and consumer advocacy groups supporting the release of these ratings because [the ratings system] improves the transparency and accessibility of hospital quality information."
Goodrich also addressed stakeholder concerns, writing that CMS "will continue to work closely with hospitals and other stakeholders to enhance the Overall Hospital Quality Star Rating based on feedback and experience" (CMS overall rating report, accessed 7/27; CMS methodology, accessed 7/27; Whitman, Modern Healthcare, 7/27; Goodrich, CMS blog, 7/27; Rau, Kaiser Health News, 7/27; CMS fact sheet, 7/27; FAH release, 7/27).