Congress Increases Heat on CMS to Delay Hospital Star Ratings

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By Michael D. Williamson

April 12 — A group of House members plans to urge the CMS to delay revamping its Hospital Compare website, according a spokeswoman for a Republican lawmaker.

The request will be made in a letter to the Centers for Medicare & Medicaid Services currently being sent around the House for additional lawmakers' signatures, Elizabeth Litzow, communications director for Rep. James B. Renacci (R-Ohio), told Bloomberg BNA April 12.

Renacci and Rep. Bill Pascrell Jr. (D-N.J.), who are leading the effort to get additional lawmakers to sign the letter before sending it to acting CMS administrator Andy Slavitt later this week, asked the agency to delay adding star ratings to the Hospital Compare website. “Quite a few” House members have already signed the letter and “we're hopeful” more will do so before it is sent, Litzow said.

A bipartisan group of 60 senators sent a nearly identical letter to Slavitt April 11.

The current Hospital Compare website has separate ratings for different quality measures, such as patient experience, outcomes and safety. Under the overhauled system, the star ratings on 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.

The CMS is scheduled to upload the star ratings to the Hospital Compare website this month, according to the House and Senate letters.

Methodology Problems

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.

House lawmakers are concerned that the hospital star ratings, in their current form, may be unfairly masking quality or, possibly, over-weighting patient experience measures and will therefore not help consumers make well-informed decisions about which hospitals to use. A number of the quality measures that underpin the ratings unfairly affect teaching hospitals that treat low socioeconomic status patients and more complex patients, and perform a greater number of complicated surgeries, the letter from House lawmakers said.

Socioeconomic Status

However, an advocacy group for Medicare beneficiaries questioned the need to adjust quality measures for hospitals that serve many patients with low socioeconomic status. The Center for Medicare Advocacy has concerns about adjusting quality ratings scores based on socioeconomic status, the group's executive director, Judith Stein, told Bloomberg BNA in an April 12 e-mail.

Hospitals treating a large population of vulnerable individuals argue that these populations cause their lower quality scores, Stein said. “However, correlation does not imply causation. Demonstrating that a hospital can have better outcomes among higher income individuals than the same hospital has among vulnerable individuals, does not prove that the vulnerable individuals have caused the poor performance,” she said.

In fact, Stein said, there is extensive research that indicates that interventions targeted specifically at addressing the needs of vulnerable populations lead to improved outcomes among these populations, lead to better quality and to correspondingly higher quality ratings scores.

The senators' letter mentioned a general concern about the star ratings system not accurately accounting for hospitals that treat patients with low socioeconomic status. However, they didn't cite the exact concerns about teaching hospitals noted in Renacci and Pascrell's letter.

When reached for comment on the senators' request, a CMS spokeswoman told Bloomberg BNA in an April 12 e-mail that the agency will respond to their letter.

Hospitals' Stance

Hospital industry groups, for their part, also have raised concerns about adding star ratings to the Hospital Compare website.

In September 2015, the American Hospital Association told the CMS that uploading the star ratings isn't likely to portray a facility's quality accurately. The Federation of American Hospitals took a stronger stance and urged the CMS to drop plans for the ratings .

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

For More Information

An unsent version of the Renacci and Pascrell letter is at http://src.bna.com/d4Z.

The senators' letter is at http://src.bna.com/d34.