The Centers for Medicare and Medicaid Services (CMS) postponed publication of its hospital ratings after numerous members of Congress objected to the rating system’s possible unfairness. The publication may now be published this month, but could see delay if there is additional pressure from industry and/or Congress.
Originally, CMS had planned to release a new star ratings system on Hospital Compare on April 21. The 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.
In its announcement to delay the publication, CMS 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. Congress is a major source of these concerns.
“Many prominent hospitals that are in the top echelon of other quality rating reports, and handle the most complex procedures and patients, will receive one or two stars (out of possible five), indicating that they have the poorest quality in comparison to other hospitals,” lawmakers wrote to CMS Acting Administrator Andy Slavitt in an April 18 letter signed by 225 members of Congress.
The lawmakers’ specific concerns included CMS’ insufficient disclosure of its methodology and the possibility the rating system gives excessive weight to the “patient experience of care” category, as reported by patients, which accounts for 25 percent of a hospital’s score, according to CMS’s Quality Net website. The remaining criteria categories are outcome (40 percent), efficiency (25 percent), and clinical process of care (10 percent).
American Hospital Association president and CEO Rick Pollack hailed the delay as “a necessary step as hospitals and health systems work with CMS to improve the ratings for patients, and the AHA commends CMS for their decision. Health care consumers need reliable, factual information to make critical care decisions.”
The American Hospital Association wrote to hospitals in a January 27 Quality Advisory report that of the 3,600 hospitals rated, 87 (2.4 percent) are expected to receive five stars and 858 (23.5 percent) to receive one or two stars.
Previously, CMS explained how it arrived at the 2016 star ratings in a report describing its methodology for calculating overall hospital quality.
The ratings, which measure hospitals on a five-star scale, took into consideration 113 measures of inpatient and outpatient quality, according to the report. The data are derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
CMS grouped quality measures in seven categories, weighted by importance. The categories and their weighting are: mortality (22 percent), safety of care (22 percent), readmissions (22 percent), patient experience (22 percent), effectiveness of care (4 percent), timeliness of care (4 percent) and efficient use of medical imaging (4 percent).
Additionally, as has been reported, last year CMS created a star rating to represent the views of patients in surveys. Two sets of researchers recently determined that hospitals with more stars in patient experience tended to have lower death and readmission rates.
Hospital Compare received 3.7 million unique page views last year, according to a paper published this in the journal Health Affairs. The author, analyst Steve Findlay, called the traffic “not at a level commensurate with [the] stature and potential” of the federal government’s health care facility comparison sites.