Becker's Clinical Quality & Infection Control

5 QUALITY MEASUREMENT & HOSPITAL RANKINGS CMS Releases Overall Hospital Star Ratings: 12 Things to Know By Heather Punke A er a three-month delay and negative chatter from many stakeholder groups, CMS released its Overall Hospital Quality Star Rating program in full July 27 on its Hospital Compare website. Here are 12 things to know about the program, its methodology, the pushback against it and how stakeholders are responding. 1. In a post on CMS' blog, Kate Goodrich, MD, director of the Center for Clinical Standards and Quality, wrote that the agency released the overall ratings "to help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side-by- side, and ask important questions about care quality when visiting a hospital or other healthcare provider." 2. e Overall Hospital Quality Star Rating combines 64 measures that are already public on Hospital Compare into one star rating. e measures fall into seven groups: mortality, safety of care, readmis- sion, patient experience, effectiveness of care, timeliness of care and efficient use of medical imaging. 3. Because the quality measures used for the overall rating reflect rou- tine care and hospital-acquired infections, specialized care provided by certain hospitals is not reflected in the ratings. 4. A hospital's rating is only calculated using as many measures for which data is available. at means hospitals' star ratings could be based on as few as nine measures or as many as 64; the average is roughly 40. 5. CMS assigns weights to the group scores (mortality, safety, readmis- sion and patient experience are each weighted 22 percent, and effec- tiveness of care, timeliness of care and efficient use of medical imaging each get 4 percent) and then assigns a summary score. If a hospital is missing data in a group, the agency redistributes the weights among the other categories. en, CMS calculates an overall rating using the summary score. 6. If a hospital doesn't have data for three measures within at least three of the seven measure groups, including one outcome group (meaning mortality, safety or readmission), the hospital doesn't get a score. Currently, 937 hospitals do not have an overall star rating. 7. CMS developed the program's methodology with input from a tech- nical expert panel and then refined it aer receiving public input, ac- cording to the agency, and CMS plans to "consider public feedback to make enhancements to the scoring methodology as needed." 8. Star ratings will be updated each quarter. Currently, 102 hospitals have five stars, 934 have four stars, 1,770 have three stars, 723 have two stars and 133 have one star. 9. e July 27 release date is roughly three months aer the planned release date on April 21. CMS delayed launching the program because of pushback it received from stakeholders and members of Congress, who argued that because the methodology is not risk-adjusted and doesn't account for socioeconomic factors, it puts certain hospitals, like academic medical centers and safety-net hospitals, at a disadvantage. 10. Per Dr. Goodrich's blog post, CMS "paused to give hospitals additional time to better understand our methodology and data" and has "conducted significant outreach and education to hospitals to understand their concerns and directly answered their questions" in the three months between the delay and the release of the program. is included hosting two national calls with more than 4,000 hospital representatives and holding meetings with hospital associations to explain data and answer questions. 11. Even with the three-month delay and tweaks to the methodolo- gy, stakeholders are still not pleased with the program. Rick Pollack, president and CEO of the American Hospital Association, called the ratings "confusing" in a statement and said the AHA is "especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor." Similarly, Chip Kahn, president and CEO of the Federation of American Hospitals, released a statement saying "the new hospital star ratings fall short and are not ready for prime time." He said there were "many important defects" in the methodology because it doesn't "recognize the oen significant differences between large and small hospitals, teaching and nonteaching, and those hospitals providing care in underprivileged areas." Bruce Siegel, MD, president and CEO of America's Essential Hospi- tals, also said AEH is "disappointed" in CMS for releasing the ratings "when so many questions remain about the data behind the ratings and their value to consumers." 12. Despite being disappointed with CMS for releasing the overall ratings right now, most stakeholder groups still back the overall goal of the program — to be more transparent and allow stakeholders to make informed decisions. "FAH will continue to work with policy makers and our healthcare partners to ensure this process is transparent and to fix the technical flaws in the star rating process so that it ultimately yields value-added information for patients as well as hospitals," Mr. Kahn said. Mr. Pollack from AHA said, "We want to work with CMS and the Congress to fix the hospital star ratings so that it is helpful and useful to both patients and the hospitals that treat them." And finally, Dr. Siegel from AEH said, "Consumers deserve accu- rate, comprehensive and relevant information to make healthcare decisions. Hospitals deserve to be on a level playing field. e star ratings accomplish neither. We urge CMS to work with hospitals and independent experts to revise the star ratings to correct shortcomings in its methodology and to immediately share all its data so hospitals can confirm the agency's calculations." n

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