Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

Will Hospital Ratings Promote Transparency or Blind Eyes?

By Jacqueline DiChiara

- Choosing a hospital based on quality of care in relation to financial factors can be an arduous task. The Centers for Medicare & Medicaid Services (CMS) is simplifying this process through its new introduction of hospital star ratings announced last week as part of an initiative from Health and Human Services (HHS) to promote quality healthcare, intelligent industry spending, and healthier beneficiaries.

CMS Hospital Ratings

Ratings are compiled from randomly collected patient experience feedback about the quality of care received amongst 3,500 Medicare-certified acute care hospitals. This data is based on measures about patients’ perspectives of hospital care collected from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS).

Twelve HCAHPS Star Ratings, one for each of the 11 publically reported HCAHPS measures, and a summary star rating combining ratings, will be released quarterly on Hospital Compare, says CMS.

CMS’ initiatives to actively promote transparency within the healthcare industry neatly align with the needs of the Affordable Care Act, which advocates the widespread distribution of public reporting to offer customer-centric content and promote quality value-based care.

Especially relevant information includes the overall strength of communication between physicians and beneficiaries, how responsive a hospital staff is in connection with patient needs, the level of cleanliness and noise within a given hospital environment, and how well patients are prepared for post-hospital settings.

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Many other organizations, such as the Nursing Home Compare and Physician Compare, are already allowing healthcare consumers to make better informed decisions regarding their healthcare options with similar rating systems.

Physician Compare’s resources allow a beneficiary to search for a physician while modifying search results via location radius, physician gender preference, Medicare-approval, and hospital affiliation.

Nursing Home Compare implements a Five Star Nursing Home Quality Rating System that considers such factors as annual health inspection complaints, quality measures (QMs) via clinical data, and staffing hours per resident per day.

Will rating information get lost in the technology shuffle?

Although the aforementioned information being openly available means increased access to hospital data, the question is, will it be analyzed or lost in the technology shuffle? Is the era of information overkill killing us softly?

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According to a slew of recent surveys, healthcare consumers tend to be relatively passive about their own healthcare needs despite their widespread internet savviness. 80 percent of healthcare consumers actively search the web for health-related information.

However, as those individuals casually browsing WebMD to resultantly erroneously consider a stuffed nose as a much serious ailment can confirm, there are indeed many accuracy limitations regarding wiki-based healthcare resources.

The chance that healthcare consumers will use information openly presented within the 12 HCAHPS ratings is dismal, according to reported data. Whether or not the resistance is due to narrow minded Google worship, a simple lack of knowing ratings exist, or a general lack of desire to understand a particular healthcare need requires further addressing so a resolution to the problem can be enacted.

There is hesitation to access information although it may be only be mere clicks away. According to a 2007 Pew Internet and American Life survey from the California Healthcare Foundation., “Despite increased overall use of the web to access health materials, only 26% of Internet users surveyed sought out ratings information on physicians or other health care professionals.”

More recently established data echoes the same idea. “Even with years of experience, extensive user testing, and resulting state-of-the-art display, we have not seen a dramatic increase in the percentage of consumers who ‘shop’ for health care providers,” confirms a 2011 Health Affairs report.

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Such low numbers may have been documented because beneficiaries may only be actively seeking information about hospital ratings during rare circumstances. Says Brent Parton, Director of Health and Policy Programs at SHOUTAmerica to the Commonwealth Fund, "Health care data is not following us as much as it should be; the onus can't be on the consumer to dig it up." Parton adds that it is only during “teachable moments” when beneficiaries seek planned or routine services and actively seek more information.

Opening up your wallet for the world to see

Despite a reported lack of healthcare provider shopping, the benefits of doing so for beneficiaries mean less headache regarding billing and financial matters. According to a statement released on behalf of the Emily Carroll, JD, of the American Medical Association (AMA), “Increased transparency in health care benefits will help patients to actively participate in decisions regarding their health care and address the root causes of problems they may experience with their health insurance companies.” 

The consumer-directed healthcare market is expanding, says Carroll, who confirms patients seek to maximize the value of their healthcare dollar and execute informed decisions about the care they receive. Offering patients with the right to such information, whether or not they utilize it, is also a primary concern with regards to billing matters and charges for specific medical services, maintains the AMA.

How accurate are hospital ratings?

Is the information acquired accurate? Regarding the accuracy of hospital ratings, CMS urges those using the information to consider multiple factors and consider such ratings as a basis of discussion about hospital quality among hospital providers and to consider the information as a baseline.

CMS states it is also developing a methodology within a contract with Yale University for a comprehensive hospital star rating that includes a full range of quality measures. CMS intends to implement an overall hospital star rating next year.

HCAHPS emphasizes it has accounted for variances within patient mixes from one hospital to the next which may affect a hospital’s HCAHPS results. It also confirms the use of a statistical clustering algorithm that identifies data gaps to promote consistency. Such methodology is the same one employed by CMS to establish Medicare Part C and Part D star ratings.

Future initiatives aim to improve transparency

Topics of transparency and disclosure have been trending throughout the past decade. According to the National Conference of State Legislatures, “States, the federal government and the private sector have enacted legal requirements and initiated programs that aim to shed light on the costs of health care services.”

Of course, healthcare beneficiaries are only one piece of the healthcare puzzle. Price transparency, such as the average charge per patient, the average charge for physician, and prices for common outpatient services or procedures will likely prove beneficial for both providers and payers. Whether or not healthcare consumers advantageously utilize this information, data being openly available to physicians and healthcare provider may encourage accurate referrals, improving the quality of value-based care.

The ultimate goal of transparency shedding light upon the financial inner working of healthcare organizations will prove especially valuable in years to come. The healthcare industry will benefit greatly from transparency promoting honesty, communication, and intelligent decisions throughout all branches and facets of its design.


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