Care to compare? Hospital five-star rating system now available

As part of its initiative to add star rating systems to its comparison websites, CMS added a five-star rating scale to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey on its Hospital Compare website. CMS described the addition of the rating system as a joint effort between it and the Agency for Healthcare Research and Quality and stated that the addition will “make it easier to for consumers to use to the information on the Compare websites.” CMS also noted that the availability of this information is consistent with the goals of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), namely its call for transparency and more widely available public reporting. Early reports on the star-rating system indicate that a limited number of hospitals received a five-star rating thus far.

HCAHPS star ratings

The HCAHPS rating system was created in order to allow consumers to more easily compare hospitals through the use of patients’ opinions that have been used to form the rating of each individual facility. The HCAHPS Survey is described by CMS as “a standardized survey instrument and data collection methodology to measure patients’ perspectives of their hospital care.” CMS has already developed star-rating systems for other comparison websites including: Nursing Home Compare; Physician Compare; Dialysis Facility Compare; and Medicare Plan Finder (see Star search: CMS imposes ratings on dialysis compare site, Health Law Daily, January 23, 2015). CMS intends to add a rating system to the Home Health Compare website later this year.

Measures and methodologies

Twelve different star-ratings are available on Hospital Compare, including one for each of 11 measures developed by CMS and supported by groupings of topics reflected in the HCAHPS survey responses and one HCAHPS summary star rating, which “combines or rolls up all of the HCAHPS star ratings… and combines all information about the specific aspects of patient experience of care measured by the HCAHPS survey.” The 11 measures are divided up into three categories of topics: (1) composite topics, which includes issues regarding nurse and doctor communication, responsiveness of hospital staff, pain management, communications about medicines, discharge information, and care transition; (2) individual topics, which includes questions about “cleanliness and quietness” of the hospital environment; and (3) global topics, which includes questions on the overall rating of the hospital and the patient’s willingness to recommend that hospital.

All hospitals that participate in the HCAHPS Survey, including all inpatient prospective payment system (IPPS) hospitals and critical access hospitals (CAHs), are eligible to receive the ratings. Yet hospitals must have completed at least 100 surveys in the 12 month reporting period to be eligible. CMS will update the ratings on a quarterly basis.

Early reports and reactions

A Kaiser Health News report explained that many are skeptical of the accuracy of the star rating system as it “won’t accurately reflect quality and may place too much weight on patient reviews.” The report also found that 251 of the hospitals rated on the site so far received a rating of 5 stars. According to Kaiser, this represents only 7 percent of all the reviewed hospitals on the comparison site. Many of these hospitals are reportedly “hospitals that focus on lucrative elective operations such as spine, heart or knee surgeries,” and which “have traditionally received more positive patient reviews than have general hospitals, where a diversity of sicknesses and chaotic emergency rooms make it more likely patients will have a bad experience.”