CMS Details Rationale Behind Hospital Quality Ratings

July 27, 2016 - Just as consumers rate restaurants on Yelp.com on a scale of one to five stars, CMS has published star ratings for healthcare facilities on its Hospital Compare website to boost healthcare transparency.

According to CMS leadership, the federal agency designed the hospital quality star ratings in order to help individual make well-informed healthcare decisions. The ratings system provides consumers with a convenient source of information for comparing and choosing healthcare facilities, according to Kate Goodrich, MD, MHS, Director of Center for Clinical Standards and Quality.

“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,” she wrote on the official CMS blog.

The updated methodology for evaluating hospitals uses 64 existing quality measures already included on the Hospital Compare website as well as consolidates them into a single rating from one to five stars, with five representing the highest overall quality.

Included in the ratings are quality measures for routine care, such as heart attack and pneumonia care delivery, as well as measures that assess hospital-acquired infections, including catheter-associated urinary tract infections. Other measures include patient experience, timely and effective care delivery, deaths, readmissions, patient safety, and use of medical imaging.

These quality measures reflect the average care that a patient can expect to receive at that specific healthcare facility, added Goodrich.

CMS used data from Medicare beneficiaries and the hospital’s general patient population, regardless of payer, to calculate the star ratings. It explained that hospitals are only evaluated on measures for which they submitted information. However, the star ratings do not account for specialized or “cutting edge” care, such as specialized cancer care.

“CMS designed the methodology to be inclusive of as many hospitals and as many measures as possible,” stated an accompanying CMS fact sheet. “This approach prevents the methodology from limiting star rating calculations to certain types of hospitals based on characteristic or size.”

Additionally, the blogpost explained how CMS delayed the publication of ratings on its website in April in order to give hospitals more time to digest the system’s methodology and data.

The agency sponsored several outreach and educational initiatives during the deferment period, including two National Provider Calls with over 4,000 hospital representatives. Through the calls, CMS explained the star rating methodology and fielded questions from the attendees.

CMS also individually met with some hospitals and healthcare associations to address concerns with the star ratings.

To help providers better understand the system, the federal agency released national distributions of the star ratings based on hospital characteristics. The data showed how all types of facilities have a range of low to high performing hospitals.

In addition, CMS reviewed the quality measures used to calculate the star ratings. It explained that most of the measures were endorsed by the National Quality Forum and adjusted for clinical co-morbidities to reflect the illness-burden of the patient population.

To address feedback that called for the inclusion of sociodemographic measures in the methodology, the agency has partnered with federal agencies that are required by the IMPACT Act to analyze the effects of socioeconomic status on hospital quality and payment programs.

Depending on the final recommendations from those agencies, CMS will appropriately adjust quality measures used in the star ratings system.

CMS reported that it will update the star ratings quarterly and modify the system’s methodology to reflect new quality measures or eliminate outdated ones. It will continue to consider stakeholder feedback to regularly improve the methodology as needed.

“Today, we are taking a step forward in our commitment to transparency by releasing the Overall Hospital Quality Star Rating,” Goodrich wrote.

“We have been posting star ratings for different for facilities for a decade and have found that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries.”

While the updated ratings are currently on the CMS-run Hospital Compare website, they may not be available for long.

Two House Representatives recently introduced a healthcare transparency bill calling for another delay of the ratings system’s release to ensure the ratings are fair and accurate.

The bill would require CMS to defer the program until July 2017 to open a 60-day comment period on the rating’s methodology and data used. A third party would also be required to validate the system’s methodology.

If enacted, CMS would have to remove the star ratings from the Hospital Compare website.

Dig Deeper:

• Will Hospital Ratings Promote Transparency or Blind Eyes?

• Healthcare Consumers Lack Transparency, Price Info Awareness