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Is the New CMS Hospital Quality Rating System Fair, Accurate?

- CMS has given the nation’s hospitals lower-than-expected marks on their new report cards thanks to an overhaul of the way hospital quality scores are being calculated.  With the patient experience placed front and center in the new Hospital Compare Five-Star Quality Rating System, healthcare organizations are puzzling over the fact that only 251 hospitals will be able to display a five-star rating on the consumer-oriented website before CMS adds other care quality metrics to the website.

CMS five-star hospital quality rankings

The new rating system is part of an ongoing effort to prove patients with better tools to make choices about their own health.  After a Government Accountability Office (GAO) report last November chided CMS for its lack of data transparency and poor resources for patients seeking to make informed financial and care quality decisions, CMS has thrown its weight behind a makeover for its suite of public-facing websites using the familiar five-star rating system.

To judge hospital quality under the new methodology, CMS is relying on the results from HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys, a standardized patient experience metric that asks patients about the responsiveness and communication abilities of clinical staff, the level of coordinated care they received, and how welcoming, quiet, and clean they found the hospital environment to be.

“The patient experience Star Ratings will make it easier for consumers to use the information on the Hospital Compare website and spotlight excellence in health care quality,” said Dr. Patrick Conway, Acting Principal Deputy Administrator for CMS and Deputy Administrator for Innovation and Quality. “These star ratings also encourage hospitals and clinicians to strive to continuously improve the patient experience and quality of care delivered to all patients.”

However, healthcare organizations are not convinced that patient experience should be the primary way they are ranked on quality.  At the moment, the patient experience ranking is the only five-star rating displayed on the site, even though CMS plans to include additional rankings for achievements like patient safety and clinical outcomes in the future.  Industry leaders are worried that patients will see the rating and select a facility based only on one single, subjective measure of hospital quality, regardless of how they may fare clinically.

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“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 Senior Associate Director of Policy. “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.”

Just seven percent of hospitals received five stars under the new system, while three percent achieved only one star.  Close to three-quarters of organizations were awarded three or four stars, while about 20 percent of the nation’s hospitals are not ranked due to insufficient patient surveys, according to data compiled by Kaiser News from CMS sources.  The new system leaves thirteen states and the District of Columbia without any five-star hospitals, but it also means 34 states escaped without any one-star organizations.

CMS believes that the patient experience is a perfect place to start when it comes to judging hospitals on the quality of care they provide, but it may be just as confusing to patients as not having any ranking data available at all.  Consumers are easily swayed by the star system, which is rather the point, but they may not dive deeply enough into the meaning behind the convenient pictogram to make a truly informed decision.  Additionally, hospitals that came out on top of the heap may boast of their five-star CMS rating in their marketing materials without mentioning that the designation is only relevant to a particular piece of the care quality picture.

As competition for patients gets tighter and more and more value-based reimbursement comes into play, hospitals chained to patient experience rankings may feel the need to spend more of their budgets on thicker doors or silkier sheets than on clinical quality improvements and health IT infrastructure investments if they feel their market share will suffer from a lower star rating.  While the patient experience is certainly an important part of ensuring quicker recoveries, better care coordination, and the development of patient loyalty, should it have been the first place for Hospital Compare to start?

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