New Hospital Quality Ratings Almost Ready, but Hospital Groups Wary

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By Michael Williamson

July 21 — New hospital quality scores from Medicare, first scheduled to appear last April, should be made public soon, the CMS said July 21.

However, hospitals want the new quality scores delayed until they are sure that facilities treating more severe health conditions won't be penalized, representatives for several industry groups told Bloomberg BNA July 21.

The Centers for Medicare & Medicaid Services intends to post the Overall Hospital Star Ratings for individual hospitals shortly, according to an agency data brief. When the CMS announced the delay, it said it would publish the new ratings this month.

Currently, the Hospital Compare website has separate ratings for different quality measures, such as patient experience, outcomes, safety and readmission rates. Under the now-delayed overhaul of the system, Hospital Compare would use a five-star rating system for consistency and alignment with existing CMS star rating efforts for other health-care providers.

However, industry groups and a bipartisan group of 285 lawmakers fear that the methodology the CMS is using to determine the star ratings will assign low scores (one or two stars) to prominent hospitals that treat the most medically complex patients.

The data brief provides information on the national distribution of overall hospital star ratings based on hospital characteristics. For each hospital characteristic, such as teaching status or safety-net status, the CMS evaluated the distribution of hospitals at each star level.

Information provided in the data brief showed that nonteaching hospitals will have better star ratings, on average, compared with teaching hospitals. In addition, safety-net hospitals will have lower star ratings, on average, than nonsafety-net facilities, the brief said.

Adjustments Needed

Overall star ratings could be improved if the CMS adjusted for patient and community level measures that assess the risk for readmission, Beth Feldpush, the senior vice president of policy and advocacy at America's Essential Hospitals (AEH), said July 21.

Some factors that go into a facility's readmission rate will affect a hospital's star ratings through no fault of its own, Feldpush told Bloomberg BNA. For example, very strong evidence shows that certain patient factors, such as not having in-home electricity or not being able to take time off from work for medical appointments, can drive readmissions, she said.

The AEH is an industry group for safety-net hospitals.

Janis Orlowski, the chief health officer at the Association of American Medical Colleges (AAMC), an industry group for teaching hospitals, agreed with Feldpush. The current rating system doesn’t take into account the important differences in patient populations and the complex conditions teaching hospitals treat, which are factors the CMS needs to rectify before posting the overall star ratings, Orlowski told Bloomberg BNA July 21.

Furthermore, the data coming out support the AAMC's concern that the CMS doesn’t understand these complexities and would steer patients away from some of the best hospitals, Orlowski said.

Those well-versed in health policy know that teaching hospitals set the standard of care and pioneer new treatments, according to Orlowski. If the CMS releases information showing that teaching hospitals have lower quality, this will hurt and confuse patients, she said.

Delay the Ratings

There's no question that the CMS should delay the ratings, as posting them in their current form would be a disservice to the public, Orlowski told Bloomberg BNA. In April, Congress also asked the CMS to include greater risk adjustments for hospitals that treat more patients with low socioeconomic status and/or more medically complex cases and the agency seems to be ignoring this request, she said (77 HCDR, 4/21/16).

It is concerning that the CMS is moving forward plans to publish the overall star ratings while Congress is away on recess, according to Orlowski. Lawmakers will likely have concerns about the timing of posting the hospital star ratings and the fact that the CMS didn't make the risk adjustments they requested, she said.

The AEH, for its part, would like further discussions with the CMS to underscore the need for more openness about the methodology it is planning to use for the star ratings, Feldpush said. If the star ratings are released, and there are mistakes, it would be difficult to issue corrections, she told Bloomberg BNA.

Another industry group, the Federation of American Hospitals, which represents for-profit facilities, expressed similar sentiments. The FAH supports star ratings but wants to ensure the system “provides accurate information about the quality of care on which patients can make a decision,” Jayne Hart Chambers, the group's senior vice president of quality, told Bloomberg BNA July 21.

Several hospital groups jointly asked the CMS earlier this month to recalculate the star ratings to better account for the differences between various types of hospitals, Hart Chambers said. “I'm not sure if that will happen” based on today's data, she added.

To contact the reporter on this story: Michael D. Williamson in Washington at

To contact the editor responsible for this story: Brian Broderick at

For More Information

The CMS data brief is at

The Hospital Compare website is at

The letter from several hospital groups to the CMS requesting readjusted star ratings is at

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