CMS Delays Hospital Star Ratings

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By Michael D. Williamson

April 20 — After strong opposition from Congress, the CMS decided to delay its planned rollout of overall quality star ratings on its Hospital Compare website by several months, an agency notification to congressional staff said April 20.

Reps. James B. Renacci (R-Ohio) and Bill Pascrell Jr. (D-N.J.), who led the House effort to delay the website changes, applauded the move April 20, as did hospital industry groups.

The Centers for Medicare & Medicaid Services had planned to add overall hospital quality star ratings to the website this month, 225 Democratic and Republican House members said in an April 18 letter to the agency.

That letter urged the CMS to delay the star ratings and followed a similar bipartisan message 60 senators sent the CMS April 11 (71 HCDR, 4/13/16).

Overall hospital quality star ratings will appear on the Hospital Compare website in July, the agency's notification said.

The current Hospital Compare website has separate ratings for different quality measures, such as patient experience, outcomes and safety. 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. For example, the Nursing Home Compare website currently uses star ratings to portray overall facility quality, while the current Hospital Compare website does not.

Methodology Questioned

In their letter, House members accused the CMS of withholding details about the methodology used to form the star ratings from hospitals.

“We have heard from hospitals in our districts that they do not have the necessary data to replicate or evaluate CMS's work to ensure that the methodology is accurate or fair,” House lawmakers said.

Moreover, adding a star rating system to the website may be misleading to consumers due to methodological flaws, both letters said. Many prominent hospitals that are in the top echelon of other quality rating reports, and handle the most complex procedures and patients, may receive one or two stars out of a possible five, indicating that they have the poorest quality in comparison with all other hospitals.

In September 2015, hospital industry groups raised similar warnings about the data the CMS planned to use for the overall quality star ratings (180 HCDR, 9/17/15).

The delay will allow institutions more time to better understand the impact of the ratings and address the flaws in the measures and methodology, Association of American Medical Colleges President and CEO Darrell G. Kirch said in an April 20 press release that largely praised the agency's move. In addition, through delaying the overall quality star ratings, the CMS will avoid providing patients with misleading information, Kirch said.

Bruce Siegel, president and CEO of America’s Essential Hospitals (AEH), an industry group for safety-net institutions, raised questions about the methodology underpinning the star ratings in an April 20 statement.

Questions remain about the data behind the star ratings and about the value of the ratings to consumers, Siegel said. “The ratings exist partially in a black box, incorporate measures that miss clinically relevant data, and fail to adjust for patient circumstances that influence health and health care outcomes—circumstances outside a hospital’s control,” he said.

Overall, however, AEH is pleased the CMS is committed to continuing to examine its methodology and better understand the unfair, adverse impacts it might have on particular types of hospitals, Siegel said. “We look forward to that process and to working collaboratively to ensure the ratings give consumers accurate, complete, and relevant information and put all hospitals on a level playing field for evaluation,” he said.

Other Reaction

Rick Pollack, president and CEO of the American Hospital Association (AHA), offered a more upbeat assessment of the delay in a statement issued April 20.

The delay is a necessary step as hospitals and health systems work with the CMS to improve the ratings for patients, and the AHA commends the CMS for its decision, Pollack said. “Health care consumers need reliable, factual information to make critical care decisions,” he said. “We will continue to share our concerns with CMS as we look for ways to make changes to the ratings system, and ensure it is useful and helpful for patients.”

Star ratings on the Hospital Compare website are meant to inform consumers' health decisions, “so we need to make sure that they are reflective of an institution's true quality,” Pascrell said in an April 20 statement released by Renacci's office. “We appreciate that CMS listened to our calls to delay the release of the ratings and will continue to consider feedback from stakeholders,” Pascrell said. He added that CMS should continue to work with the hospital community to address concerns with the methodology and ensure that the results are accurate.

Renacci in the release characterized the delay as a “great win for hospitals in Northeast Ohio and across the country.”

May Call Planned

Over the next 60 days, the CMS plans to “listen to stakeholders” and will provide further guidance about the star ratings, the notification said.

In addition, the CMS will host a National Provider Call May 12 to answer questions about the planned star ratings. “The call is intended to be informative, helping hospitals understand their hospital specific reports and to explain the methodology in detail,” the agency notification said.

To contact the reporter on this story: Michael D. Williamson in Washington at mwilliamson@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com

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