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House Requests CMS Delay Quality, Value-Based Care Ratings

In a recent letter to CMS, 225 House members asked the agency to delay the release of the Hospital Compare star ratings because the system does not adequately assess value-base care.

By Jacqueline LaPointe

- A group of 225 members of the House of Representatives recently wrote a letter urging CMS it to delay the release of the hospital star rating system because it does not include relevant quality measures for assessing value-based care and the methodology is not transparent.

House members urge CMS to delay value-based care ratings

The star ratings system evaluates hospitals on a scale of one to five stars for hospital quality and publishes the results on the CMS-run Hospital Compare website. The website is designed to help consumers make more informed decisions about where they receive care.

The House members stated that the ratings system does not take into account the necessary quality measures, such as chronic disease management and socioeconomic status of patients, to evaluate value-based care.

“While we strongly support public reporting of provider data, we urge you to ensure that this data adequately accounts for hospital patient mixes that include higher proportions of patients with multiple complex chronic health conditions and lower socioeconomic status,” explained the letter.

The hospitals that care for these patients must perform complex procedures and manage difficult conditions. Hospitals should not be penalized for handling complicated cases that skew quality ratings if they are not weighed appropriately in the methodology, the letter pointed out.

“We want to work together to ensure that hospitals are not penalized for treating the most vulnerable or complex patients in the star ratings system, the Hospital Readmissions Reduction Program, or any other quality program,” explained the House members.

Additionally, the letter asked CMS to release more information about the ratings system methodology to healthcare providers and stakeholders.

“We have heard from hospitals in our districts that they do not have the necessary data used to replicate or evaluate CMS’s work to ensure that the methodology is accurate or fair,” wrote the House members. “We believe that additional time is necessary for hospitals and stakeholders to thoroughly review the data and understand the impact of the current methodology to ensure the validity and accuracy of the information before it is publicly released.”

Without relevant quality measures and a transparent methodology, the signatories explained that the current hospital comparison system does not provide consumers with a comprehensive evaluation of hospitals.

“We are concerned that the hospital star ratings, in their current form, may be unfairly masking quality or, possibly, over-weighting of patient experience measures and will therefore not help consumers make well-informed decisions about which hospitals to use,” stated the letter.

The letter responds to the recent changes by CMS to how hospitals are assessed in the star ratings.

On April 21, CMS is scheduled to release updated star ratings that measure patient survey results, effective and timely care, readmissions, deaths, complications, use of medical imaging, quality to payment correlations, and Medicare volume.

Previous star ratings were determined using only the data from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. The survey was consumer-centric and asked patients to evaluate their experience with the hospital, its staff, and patient care.

The House members in the letter, as well as other industry groups, stated that the stars rating system over-emphasizes the patient experience and neglects important clinical quality measures.

A ratings system based on patient experience may lead hospitals to concentrate more on keeping patients happy rather than providing the best possible treatments in a timely manner.

Sixty senators have also signed a similar letter to CMS citing irrelevant clinical quality measures and lack of transparency as reasons for delaying the star ratings release on April 21.

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