- Buckle up. The Centers for Medicare & Medicaid Services (CMS) is giving its Hospital Quality Star Rating System a vigorous test drive to review its production process, increase system understanding, and provide an opportunity for hospital feedback.
Although the generally helpful concept of booking a hotel room, choosing a restaurant, or making online purchases based solely on a perusal of star ratings is one that evokes innate familiarity, how will a star ratings system translate when it comes to assessing the ever complicated entity of a hospital?
Last April, CMS posted star ratings for hospital performance based on patients’ experience of gauged care. Beginning in mid-July and ending in mid-August, CMS’s dry run will be conducted via a question and answer period to answer queries from hospitals, Quality Improvement Networks (QINs), and various stakeholders determine they require more information about.
“CMS is committed to supporting hospitals throughout the dry run,” CMS confirms, adding that each hospital will receive a Hospital-Specific Report (HSR) and accompanying user guide with its Star Ratings results and an explanation of how they were determined. Hospital ratings are available on the Hospital Compare website.
"The overarching goal of Hospital Star Ratings is to improve the usability and interpretability of information posted on Hospital Compare for patients. CMS is exploring a methodology with patients, doctors, and statisticians to summarize results of all measures currently posted on Hospital Compare by developing an overall star rating for each hospital,” states Quality Net via CMS. “Hospital Star Ratings provide patients with a simple summary rating — designed by patients, doctors, and statisticians — which combines multiple dimensions of quality into a single score,” the website adds.
Are we merely shooting for the moon?
As RevCycleIntelligence.com reported, there have been mixed reviews across the healthcare industry spectrum regarding the overall efficiency of a star rating system. Although a reported 80 percent of healthcare consumers actively conduct online research for health-related information, available information may lack accuracy, serving more as a subjective baseline than as valid knowledge.
The question also remains if star ratings will result in actionable, intelligent decision making, as RevCycleIntelligence stated. Glitches are apparent and the devil is indeed in the details. For instance, very few hospitals, as HealthITAnalytics.com reported, secure the highest/best 5-star rating. Twenty percent of the nation’s hospitals are not ranked due to “insufficient” patient surveys. There were, perhaps oddly, no 1-star ratings administered among 34 states.
The American Hospital Association weighs in
In reaction to CMS’s proposed test drive, the American Hospital Association (AHA) advises CMS “exercise considerable care” while developing tangible execution of its star ratings approach.
As Linda E. Fishman, AHA’s Senior Vice President for Public Policy and Development, states in a letter to Patrick Conway, MD, CMS’s Chief Medical Officer and Deputy Administrator for Innovation & Quality, “America’s hospitals were instrumental in the creation of Hospital Compare more than a decade ago, and remain strongly committed to sharing meaningful, accurate hospital quality information with the patients they serve. It is critical that such information is presented in an understandable manner.”
Although there is valuable appeal in the simplified “at a glance” view via a star ratings system, Fishman urges CMS to adapt a topical star rating which will likely prove more valuable to patients. “[We] question whether a single summary star rating will equip patients, families and communities with a meaningful, accurate picture of hospital quality that is relevant to their individual reasons for seeking care,” states Fishman. “Moreover, we are not confident that the measures available on Hospital Compare at this time will enable CMS to create a single, methodologically sound rating of all aspects of hospital quality,” she adds, expressing further concern that a single, methodologically sound star rating system reflecting complete hospital quality may not be feasible.
“[We] urge CMS to assess all cost and efficiency measures it intends to include in star ratings for the impact of sociodemographic factors, and to apply an adjustment if warranted,” Fishman maintains. “Sociodemographic adjustment is especially important to consider for any measure assessing cost performance in the period after hospital discharge since the availability of resources in communities to aid in patient recovery – and therefore help reduce the likelihood of utilizing expensive services – would likely affect hospital performance,” she adds.