- In a recent letter, a group of sixty senators urged CMS to delay the release of the Hospital Compare Star Ratings because the current methodology for rating hospital quality does not include all relevant quality measures and the process is not transparent to healthcare providers.
The Star Ratings system is used on the Hospital Compare website, which provides consumers with a simple method for comparing hospitals and making decisions about where they receive care.
The letter stated that the quality measures used for assessing hospitals does not account for patients with low socioeconomic statuses or multiple chronic conditions. The hospitals that manage these cases perform complex procedures and handle difficult diseases, which should be weighed in the rating system.
“We are concerned that the Star Rating system may be misleading to consumers due to flaws in the measures that underpin the ratings,” wrote the senators. “Many prominent hospitals that are in the top echelon of other quality rating reports, and handle the most complex procedures and patients, may receive 1 or 2 stars (out of a possible 5), indicating that they have the poorest quality in comparison to all other hospitals.”
Additionally, the senators asked CMS to release more information on the methodology used for evaluating hospital quality and provide hospitals with the data.
“As a result, we have heard from hospitals in our states that have been unable to replicate or evaluate CMS’s work to ensure that the methodology is accurate or fair,” stated the letter. “It is clear that additional time is necessary for hospitals and stakeholders to thoroughly review the data and understand the impact of the current methodology to ensure the validity and accuracy of the information before it is publicly released.”
The letter responds to recent changes by CMS to the Star Ratings evaluation procedure.
The ratings that are set to be released later this month were evaluated on patient survey results, timely and effective care, readmissions, complications, deaths, use of medical imaging, linking quality to payment, and Medicare volume.
Previous Star Ratings were calculated using only the data from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. The survey asked patients to rate the responsiveness and communication skills of clinical staff, the level of care coordination, and the hospital environment.
While CMS implemented the system to increase transparency and provide a more consumer-facing comparison website, many industry groups felt the Star Ratings were one dimensional.
“Hospitals are leaders in sharing quality and safety information to help patients make informed decisions about their health care,” said Akin Demehin, American Hospital Association (AHA) Senior Associate Director of Policy in a previous letter to CMS. “While star ratings could be an effective way to make quality information easier to understand, the devil is in the details. There’s a risk of oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons.”
AHA encouraged CMS to add clinical quality measures that were more relevant to patient experience and physician quality. Most of the quality measures were too narrow and did not apply to most hospital patients.
The group also stated that sociodemographic adjustment is important for measuring quality and cost because lower socioeconomic patients might not have access to local resources that would help patient recovery and prevent expensive healthcare services.
In addition to rating system challenges, many healthcare providers and stakeholders found quality reporting to be time-consuming, expensive, and clinically irrelevant.
A Health Affairs recent survey reported that physicians in four common specialties spent approximately $15.4 billion per year completing quality reporting activities for payers. Furthermore, 27 percent of physicians stated that the reporting agency’s benchmarks were not representative of quality care.
The study showed that physicians were required to report on over 3,000 competing quality measures for government and private programs.
While the majority of healthcare providers and stakeholders applaud CMS for attempting to create a comprehensive quality reporting system, there still some work to be done with how hospital quality measures are reported and presented to consumers and the healthcare community.