Becker's Clinical Quality & Infection Control

63 PATIENT SATISFACTION AND QUALITY MEASUREMENT CMS Delays Overall Hospital Star Ratings Release: 4 Things to Know By Heather Punke O n April 20, just one day before its scheduled public launch, CMS postponed the release of its overall hospital star ratings program to July, the agency said in a statement. Here are four things to know about the pro- gram, its controversy and its future. 1. CMS had planned to release a new star ratings system on Hospital Compare on April 21. e current star ratings, which went live in April 2015, incorporate only patient experience scores, and the new overall star ratings intend to include quality measures such as readmissions, mortality, effectiveness of care and timeliness of care in addition to patient experience scores. 2. Aer the program's final methodology was announced in January, several stake- holders spoke out against the ratings system. A group of 60 senators sent a letter to Andy Slavitt, acting administrator of CMS, urging CMS to delay releasing the ratings because of concerns the system "may not accurately take into account hospitals that treat patients with low socioeconomic status or multiple complex chronic conditions." Members of the House also sent a similar letter, according to Kaiser Health News. Addition- ally, several hospital groups sent a similar letter to Mr. Slavitt in March, stating "serious concerns that these star ratings will be mis- leading to consumers" because the ratings would use measures that are not properly risk-adjusted. 3. In the April 20 statement from CMS, the agency said it developed its methodology in coordination with many stakeholders, but it would delay the overall star ratings release in response to "targeted concerns about specific calculations" and feedback from stakeholders. 4. Prior to the new July release date, the day of which has not been specified, CMS plans to listen to stakeholders — people with ques- tions on the methodology can email cmsstar- ratings@lantanagroup.com — and work with hospitals on their data — a national provider call is scheduled for May 12. Aer the star ratings go live "in their first iteration," the agency plans to "refine and improve the site," according to the statement. n Experts Suggest 3 Ways the US Can Improve Healthcare Quality Measurement By Heather Punke W hile the U.S. healthcare industry has made strides toward eliminating adverse events, many problems still remain. And one thing could be holding the industry back from achieving the goal of zero adverse events, according to a JAMA article published in April: good measures of quality and patient safety. "The healthcare industry lacks valid patient safety measures, which are fundamental to improvement. Without these measures, the key ingredient in these efforts is missing… Without effective measurement and reporting, progress in patient safety will be arduous and slow," wrote Ashish Jha, MD, and Peter Pronovost, MD, PhD, in the piece. Dr. Jha is with the Department of Health Policy and Man- agement of the Harvard T.H. Chan School of Public Health in Boston, and Dr. Pronovost is with the Armstrong Institute for Patient Safety and Quality and Johns Hopkins Medicine in Baltimore. In the JAMA piece, Drs. Jha and Pronovost provided three suggestions as to how policy makers and government agen- cies can improve quality measurement in healthcare, thereby furthering the goal of reducing adverse events to zero. 1. CMS can eliminate unnecessary or ineffective metrics from the programs it runs. The authors suggest cutting PSI-90 as a measure and instead focusing on the adverse events that tend to cause the most harm: adverse drug events, nosocomial infections, venous thromboembolism, pressure ulcers, falls, surgical complications and diagnos- tic errors. 2. CMS can also task an agency with "defining standards of what makes good measures and setting accuracy re- quirements before implementing measures in pay-for-per- formance and public reporting," the authors wrote. The agency could provide a common set of "sound" metrics. 3. Congress needs to fund research on systems engi- neering in the healthcare industry. "Improving safety depends on having good systems in place rather than on the efforts of individual clinicians. As such, the govern- ment — the largest payer in healthcare — needs to fund practically applicable studies on systems engineering to promote efficient, safe healthcare," the JAMA piece reads. n

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