Lawmakers’, hospitals’ wish upon star ratings temporarily granted

To the approval of lawmakers and various hospital and medical school associations, CMS delayed its intended April 21, 2016, release of overall hospital quality star ratings on its Hospital Compare website until at least July 2016. The delay is partly attributable to efforts raising concerns about whether the involved methodology for star ratings provided a fair, accurate, and meaningful representation of hospital performance. The lawmakers and associations noted that a number of the quality measures that are the ratings’ foundation impact teaching hospitals that treat low socioeconomic status patients, more complex patients, and perform various complicated surgeries. In addition to delaying the star ratings, the regularly scheduled update of data on individual Hospital Compare measures will be delayed until May 4, 2016.

CMS believes that star ratings spotlight excellence in health care quality and make it easier for consumers to use the information on the Hospital Compare website (see Care to compare? Hospital five-star rating system now available, Health Law Daily, April 16, 2015). This is consistent with the call for transparent, easily understood, and widely available public reporting found in the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). The ratings also support using quality measures as a key driver of health care system improvement.

Concerns

Lawmakers had weighed in on the matter a few days earlier, urging CMS to delay the release and reevaluate its methodology. In a letter to CMS Acting Administrator Andy Slavitt, 60 Senators and 225 Representatives stated concerns that the hospital star ratings, in their current form, could unfairly mask quality or overweigh patient experience measures, which in turn would not help subsequent consumers make well-informed decisions about hospital choices.

It was noted that CMS had provided insufficient details regarding the methodology used to determine the star ratings, and that the agency had not provided hospitals with the data used to derive the ratings. Hospitals did not have the data to replicate or evaluate CMS’ work to determine whether the methodology was fair or accurate.

In addition, the American Hospital Association (AHA), Association of American Medical Colleges, America’s Essential Hospitals, and Federation of American Hospitals stressed the importance of appropriately adjusting for socioeconomic status and patient complexity in the star ratings. The associations noted that CMS had previously considered socioeconomic factors for Medicare Advantage and Medicare Part D programs. For instance, the Medicare Payment Advisory Commission (MedPAC) reported and recommended improvements for outpatient and inpatient facilities to further the ACA push to reevaluate the fee-for-service system drawbacks of rewarding quantity rather than quality of health care services (see MedPAC recommends Medicare reform in 2015 report to Congress, Health Law Daily, March 18, 2015). Both the lawmakers and the AHA asked CMS to incorporate the socioeconomic status on quality measures into future star ratings.