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A government website that provides patients with information about hospital quality is getting praise for promoting transparency but little else.
Hospital Compare, launched by the Centers for Medicare & Medicaid Services in 2016, is aimed at encouraging facilities to improve their quality of care and enabling prospective patients to choose the facility that is best for them. The agency said it intends to update the site twice a year, and in December, it started displaying overall hospital star ratings and data on quality measures for 3,692 Medicare hospitals. The ratings range from one to five stars, with five being the best.
Opinions of the site among hospital groups and lawyers range from “a good first step” to “unsalvageable.”
Alex Brill, a policy adviser at Hooper, Lundy & Bookman’s Washington office, said the site is a “useful first step in an effort by the government to improve transparency and provide patients with comparative data on the hospital they may attend.”
Hospital industry groups, however, say the site is not useful to patients, who typically don’t shop around for hospitals the way they do for hospice and nursing home care.
“We don’t have any evidence that Hospital Compare is being used consistently by patients,” Janis Orlowski, chief health care officer at the Association of American Medical Colleges, told Bloomberg Law Jan. 4. “The information provided is not good or helpful to the public and may mislead people.”
She added that it is easy to rig the ratings system, as some hospitals may report only specific measures that make them look good, increasing their overall rating.
Maryellen Guinan, senior policy analyst at America’s Essential Hospitals, an industry group for safety-net hospitals, criticized the site’s use of a single overall rating, as picking a hospital is a complicated choice.
“Shopping for a hospital should not be the same as shopping for a toaster or an oven,” she told Bloomberg Law Jan. 4.
Guinan added that low-income hospitals are unfairly underrated under the system. Safety-net hospitals often serve clinically complex patients who are affected by socioeconomic factors, including poverty, and as a result have higher readmission rates. These factors are not taken into account within the ratings methodology and may result in lower overall scores.
“There is not an equal playing field in this ratings system as many of these measures are ones that hospitals cannot control,” Guinan said. “At this point, it would benefit both providers and patients to hit the pause button and revisit the methodology and quality measures.”
Rita Numerof, co-founder and president of Numerof Associates, a health-care consulting firm based in St. Louis, said she isn’t surprised that hospitals are critical of the ratings system.
“Industry executives have been very reluctant to do public reporting,” she told Bloomberg Law Jan. 4. “If the industry had done a better job at policing itself more effectively, they wouldn’t need this forced focus on transparency.”
Numerof added that the site is “not perfect” and called it a “work in progress.”
The ratings system does not penalize hospitals for poor performance or low ratings. Fred Bentley, vice president at the consulting firm Avalere Health, said the public display of the ratings are enough to coerce hospitals to make positive changes.
“The measures need to be refined but it’s a good starting point,” he told Bloomberg Law Jan. 4. “These organizations need to be held accountable for quality of care in some way, and basic transparency is the start to that.” He added that the CMS in the future is likely to make adjustments to current measures instead of adding additional ones.
Orlowski, however, was skeptical that the program could be fixed in a way that satisfies hospitals.
“I think that there have to be substantial changes in order for it to help the American public,” she said. “I am not optimistic that this can be salvaged.”
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The hospital compare website is at www.medicare.gov/hospitalcompare/search.html.
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