Hospital Stars to Be Revealed?

How do patients determine if a particular hospital is providing a good quality of care? For a number of years CMS has been posting data on the quality of care provided at hospitals on its website Hospital Compare.   However, CMS is concerned that beneficiaries are not able to use the data on that website to make a good determination.  CMS fears it might be too overwhelming because they post about 100 quality indicators on the Hospital Compare website.  CMS’ solution?  It’s in the Proposed rule updating the hospital inpatient prospective payment system (IPPS) for 2014.  CMS said, “one option we have considered is aggregating measures in a graphical display such as a star rating.”  Where did they get this idea?  They are using it already.

SNF Star Rating System

CMS already uses a five-star rating systems for skilled nursing facilities (SNFs) on its Nursing Home Compare Website.  Launched in 2008, the “Five Star Quality Rating System” for nursing homes  measures a SNF’s performance on (1) health inspections; (2) staffing; and (3) quality measures.  Each nursing home is given one to five stars for each of the three categories above and then an overall star rating is given to the entire facility.  The methodology used for assigning stars is explained on the Nursing Home Compare website.  It is expected that CMS would use its experience with the “Five Star Quality Rating System” for SNFs when developing methodology for a five-star rating system for hospitals.

Hospitals Unsure

The Association of American Medical Colleges wrote CMS a letter in late June of 2013 saying that it “strongly opposes the use of a star rating system, which may make inappropriate distinctions for hospitals whose performance is not statistically different.”  In addition, the AAMC’s letter stated that “a  star rating system can also exaggerate minor performance differences on measures.”

In an interview for the Kaiser Health News (KHN), Peter Slavin, president of Massachusetts General Hospital, said that much of the data used for quality measures is obtained from hospital bills submitted to Medicare, which he said is “a lot like judging the quality of a restaurant from the checks they give to their customers.”    KHN reported that Slavin thinks ranking a  hospital system is a good idea but that it needs to be based on more sophisticated data than is now available. “The quality information we’re now using in health care is pretty crude and needs to get a lot better,” said Slavin.

Existing Rankings

Numerous private organizations like the Joint Commission, U.S. News and World ReportConsumer Reports, and Leapfrog rank hospitals and comment on the quality of care provided. Some worry that the variety of different factors used by these organizations to measure quality can be confusing.  Some of the factors used by these private organizations can be quite subjective. For example, reputation is 32.5 percent of the score in the U.S. News and World Report’s ranking according to its methodology, while patient safety is only 5 percent.

Soon though, hospitals will know if they will start seeing stars by their name on government websites.  The 2014 IPPS Final rule is expected to be published in the next few weeks and CMS may provide an answer to this question at that time.