Few U.S. hospitals attain five-star quality of care

Only 2.2 percent of U.S. hospitals earned a five-star quality rating from CMS in its Overall Hospital Quality Star Rating (Star Rating) system, which reflects the level of patient care received. According to a CMS data brief preview and evaluation, 934 hospitals, or 20.3 percent, received a four-star overall hospital quality star rating. The most common rating was three stars, which was received by 1,770 hospitals, or 38.5 percent. Two stars were given to another 723 hospitals, or 15.7 percent, and 133, or 2.9 percent, received only one star.

Notably, another 937 hospitals, or more than 20 percent, were not assigned a rating. No star rating is assigned to hospitals that do not report or do not have the requisite minimum amount of data, which can occur for small or new facilities.

CMS’ Star Rating takes 62 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars. Quality measures range from the routine care an individual receives when being treated for heart attacks and pneumonia to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections.

Transparency

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.

CMS had previously 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 was partly attributable to efforts raising concerns about whether the involved methodology for star ratings provided a fair, accurate, and meaningful representation of hospital performance.

Lawmakers and associations, alike, noted that a number of the quality measures that are the ratings’ foundation impact teaching hospitals that treat patients of low socioeconomic status, treat more complex patients, and perform various complicated surgeries (see Lawmakers’, hospitals’ wish upon star ratings temporarily granted, Health Law Daily, April 21, 2016).

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.