CMS Hospital Star Rating to Address Concerns on Underrating Critical Access Hospitals

The Trump administration released a long-awaited proposal to change how their star ratings posted on the Hospital Compare website are calculated, saying they aim to make the new methodology simpler and address concerns held by the industry about the scoring. The proposed change was placed in a proposed payment rule released by the Centers for Medicare & Medicaid Services for outpatient hospital departments and ambulatory surgical centers.

Proposed Changes

A hospital star rating is based on their performance on specific quality measures. However, it is argued the model is too unpredictable and complex. Groups want a more easily understood methodology that can be explained to patients and used for quality improvement. This proposal would discontinue the use of the latent variable modeling (LVM), which combines and summarizes multiple pieces of information and is used to calculate a hospital’s star rating.

Instead, CMS would adopt a “simple average of measure scores to calculate measure group scores,” the proposed rule stated. “This method would average the measure scores a hospital reports within a given measure group, which have been standardized, to calculated the measure group scores.”

CMS would take 100% divided by the number of measures reported to give the percentage that each quality measure would weigh. If a hospital reports all eight measures in the Safety of Care measure group, then the measure weights would be determined by calculating 100% divided by the eight measures that are reported.

The agency also wants to consolidate three measure groups: effectiveness of care, timeliness of care and efficient use of medical imaging into one process measure group: Timely and Effective Care. It would be part of a steady reduction of measures in the CMS quality programs, from 64 measures in the first publication of the star rating in 2016 to 51 in January of this year.

The American Hospital Association said “[i]n light of the substantial flaws with CMS’s current approach to hospital star ratings, we appreciate that the agency is exploring ways of improving the methodology. We look forward to reviewing the proposed methodology changes in depth.”

America’s Essential Hospitals noted it is “pleased the agency is working to fix flaws in the hospital star ratings program, and we look forward to additional improvements.”