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CMS Drops First Hospital Star Ratings Since Methods Overhaul

The Hospital Star Ratings calculation changes are a good first step, experts agree, but some say more change is necessary.

The Centers for Medicare & Medicaid Services (CMS) has unveiled its latest updates of the Hospital Star Ratings, its first report since the agency restructured the methodology for assigning clinical quality star ratings.

Overall, 4,685 hospitals received a rating from CMS, with most getting a three-star rating (30.34 percent). Another 29.45 percent got a four-star rating and 13.56 percent got a perfect five-star rating.

About one in five hospitals received a two-star rating, but only 6.06 percent got a dismal one-star rating, CMS reported on its website.

The CMS Hospital Star Ratings are a key score of clinical quality that help inform value-based payments. The higher the score, the higher the quality and therefore the higher the reimbursement. However, the agency has long asserted that the Hospital Star Ratings are also a patient engagement tool that helps patients and families make decisions about healthcare access.

The familiar five-star scale should help patients identify top-performing hospitals for any of their planned visits, like a birth or elective surgery. Patients and their families or caregivers can view Hospital Star Ratings via the CMS Hospital Compare website.

This is the first update of the Hospital Star Ratings since CMS overhauled its methodology. Healthcare stakeholders have long scrutinized the agency for making apples to oranges comparisons in the Hospital Star Ratings. Others have indicated that it is reductive to use such a simple scale to reflect the complexities of patient safety.

These methodology updates aim to address some of those issues. Hospitals are now beholden to reporting applicable measures within five measure groups: mortality, safety of care, readmission, patient experience, and timely and effective care. On average, hospitals usually report around 37 measures across each of those five groups, CMS said.

CMS then averages a score within each of those measure groups and calculates a weighted average across those groups. This yields the single hospital summary score.

Each measure group is weighted at 22 percent of the overall score, except timely and effective care, which CMS weights at 12 percent. The agency reallocates the scale if a hospital cannot report in a certain measure group.

In an effort to ameliorate the apples to oranges comparisons, CMS also places hospitals into peer groups determined by the number of measures a hospital offers. Hospitals that report in more measure groups will stack up against other hospitals reporting more measure groups; those reporting fewer will compare to their peers.

CMS uses k-means clustering to assign star ratings within peer groups.

Not every hospital is able to report every measure, CMS noted. Hospitals that report in at least three measure groups, two of which needing to be mortality or safety of care, qualify for an overall star rating.

Industry groups like the American Hospital Association (AHA), which has previously been very critical of the CMS Hospital Star Ratings, said these updates represent a good first step but more action is necessary.

“Today’s star ratings update is an improvement that will likely make the ratings more useful for both patients and hospitals,” Ashley Thompson, AHA senior vice president of Public Policy Analysis and Development, said in a statement.

AHA acknowledged the “simple averages” CMS is now using, as well as the way the agency has reorganized certain measures into measure groups.

“These changes have made the star ratings easier to interpret, more insightful for hospitals working to improve their quality of care, and more balanced in favor of high-priority topics, like infections,” Thompson said.

“However, certain changes might not have the effect that CMS hopes, and there remain flaws in the methodology that CMS must address,” she continued.

For example, the CMS Hospital Star Ratings still fail to account for social risk factors, which AHA said seriously affect the way hospitals can take care of their patients. AHA suggested that including social risk factors into the Hospital Star Rating calculation would ensure hospitals taking care of more traditionally marginalized patients would have a fairer shot.

AHA also said the peer groups, although a good first step, need some refinement to truly demonstrate “equitable comparisons,” Thompson wrote.

“Finally, and importantly, because the star ratings methodology has changed so frequently and significantly since its inception, comparing a hospital’s latest overall star rating with a previous rating could be very misleading,” Thompson concluded. “The AHA remains committed to working with CMS on our shared goal: providing patients with accurate, purposeful information about quality.”

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