See How CMS Has Rated Your Local Hospital

NYAPRS Note: CMS has updated rating scores for consumers to use in selecting their local hospital of choice. See how your hospital rated at The article below suggests that hospital groups have some difficulty with the rating system.


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July 27, 2016

By: Kate Goodrich, MD, MHS, Director of Center for Clinical Standards and Quality

Helping Consumers Make Care Choices through Hospital Compare

When individuals and their families need to make important decisions about health care, they seek a reliable way to understand the best choice for themselves or their loved ones. That’s why over the past decade, the Centers for Medicare & Medicaid Services (CMS) has published information about the quality of care across the five different health care settings that most families encounter.[1]

These easy-to-understand star ratings are available online and empower people to compare and choose across various types of facilities from nursing homes to home health agencies. Today, we are updating the star ratings on the Hospital Compare website to help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side-by-side, and ask important questions about care quality when visiting a hospital or other health care provider.

Today’s ratings include the Overall Hospital Quality Star Rating that reflects comprehensive quality information about the care provided at our nation’s hospitals. The new Overall Hospital Quality Star Rating methodology takes 64 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars. The rating includes quality measures for routine care that the average individual receives, such as care received when being treated for heart attacks and pneumonia, to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections. Specialized and cutting edge care that certain hospitals provide such as specialized cancer care, are not reflected in these quality ratings.

We have received numerous letters from national patient and consumer advocacy groups supporting the release of these ratings because it improves the transparency and accessibility of hospital quality information. In addition, researchers found that hospitals with more stars on the Hospital Compare website have tended to have lower death and readmission rates.[2],[3]

Prior to publishing the Overall Hospital Quality Star Rating, we paused to give hospitals additional time to better understand our methodology and data. In response, we delayed the release of the ratings. Since then, we have conducted significant outreach and education to hospitals to understand their concerns and directly answered their questions, including:

  • Hosting two National Provider Calls with over 4,000 hospital representatives. During the calls, we walked through the Overall Hospital Quality Star Rating data and the methodology in detail while responding to questions that the attendees raised.
  • Providing specialized assistance to hospitals. We held numerous meetings with the hospital associations and individual hospitals to explain their data and answer questions.
  • Posting an evaluation of the national distributions of the Overall Hospital Quality Star Rating based on hospital characteristics. The analysis shows that all types of hospitals have both high performing and low performing hospitals.
  • Subjecting the measures used to calculate the Overall Hospital Quality Star Rating to rigorous scientific review and risk adjustment. All of the measures used to calculate the Overall Hospital Quality Star Rating are based on clinical guidelines and have undergone a rigorous scientific review and testing. The vast majority are endorsed by the National Quality Forum. Most of these quality measures are already adjusted for clinical co-morbidities to account for the illness-burden of the population. Some hospitals have raised the question of making additional adjustments to account for the sociodemographic characteristics of the patients they serve. We continue to work closely with the National Quality Forum and the Assistant Secretary for Planning and Evaluation (ASPE), who is required by the IMPACT Act to study the effect of socioeconomic status on quality measures and payment programs based on measures. We will work with ASPE and determine what next steps, if any, should be taken to adjust our measures based on the recommendations in the report.

CMS will continue to analyze the star rating data and consider public feedback to make enhancements to the scoring methodology as needed. The star rating will be updated quarterly, and will incorporate new measures as they are publicly reported on the website as well as remove measures retired from the quality reporting programs.

Today, we are taking a step forward in our commitment to transparency by releasing the Overall Hospital Quality Star Rating. We have been posting star ratings for different for facilities for a decade and have found that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries. We will continue to work closely with hospitals and other stakeholders to enhance the Overall Hospital Quality Star Rating based on feedback and experience.

These star rating programs are part of the Administration’s Open Data Initiative which aims to make government data freely available and useful while ensuring privacy, confidentiality, and security.

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[1] CMS Compare websites include: Nursing Home Compare; Physician Compare; Medicare Plan Finder; Dialysis Compare; and Home Health Compare.

[2] Wang DE, Tsugawa Y, Figueroa JF, Jha AK. Association Between the Centers for Medicare and Medicaid Services Hospital Star Rating and Patient Outcomes.JAMA Intern Med.2016;176(6):848-850. doi:10.1001/jamainternmed.2016.0784.

[3] Trzeciak, S. Gaughan, J. Mazzarelli, A. Association Between Medicare Summary Star Ratings and Clinical Outcomes in US Hospitals. Journal of Patient Experience. 2016vol. 3no. 12374373516636681 doi:10.1177/2374373516636681

CMS releases star ratings for hospitals

ByElizabeth Whitman Modern Healthcare July 27, 2016

The CMS published the much-anticipated Overall Hospital Quality Star Ratings on Wednesday afterindustry stakeholdersand Congress pressured the agency to continue to delay their release.

The ratings are a composite metric of one to five stars, with five being the best. They intend to convey the overall quality of nearly 4,000 hospitals in the U.S and are posted to the CMS'Hospital Compare site. In grading hospitals on their overall quality, the CMS used 64 measures, such hospital-acquired infection rates or emergency room wait times, that had already been posted to the Hospital Compare site. It grouped those measures into broader categories, then weighted them. Hospitals had to meet minimum reporting requirements in order to be eligible to receive a star rating.

"These easy-to-understand star ratings are available online and empower people to compare and choose across various types of facilities from nursing homes to home health agencies," Dr. Kate Goodrich, director of the Center for Clinical Standards and Quality at CMS, wrote in ablog postannouncing the star ratings' release.

Hospitals and other industry groups have stridently criticized the rating system as oversimplifying a complex matter—the quality of a multi-faceted institution—and the underlying methodology as flawed. They warned it would provide inaccurate information to consumers and damage hospitals' reputations.

The American Hospital Association said it was "disappointed" the CMS decided to release the ratings. "As written, they fall short of meeting principles that the AHA has embraced for quality report cards and rating systems," its president, Richard Pollack, said in a statement Wednesday. "We are especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor."

On average, safety net hospitals hospitals earned slightly lower ratings, with a mean of 2.88 stars, than did non-safety net hospitals, which garnered an average rating of 3.09 stars, according to distributiondatareleasedThursday by CMS.

Just 102 institutions out of 4,599 hospitals, or 2.2%, earned five stars. Of the rest of the hospitals, 20.3% garnered four stars, 38.5% received three, 15.7% earned two stars and 2.9% received a single star. A significant proportion—20.4% of hospitals—were deemed ineligible for ratings, because they lacked data to report measure results.

"This does not necessarily mean that a hospital did not report any data, or that a hospital provides poor quality care," Aaron Albright, CMS's director of media relations, said in an email. "The facility could be new or small, or have an insufficient number of cases reported."

The CMS originally planned to release the star ratings in April, butbacked offafter 60 senators and 225 representatives penned letters calling for CMS to wait.

“We have heard from hospitals in our districts that they do not have the necessary data to replicate or evaluate CMS's work to ensure that the methodology is accurate or fair,” the letter from the representatives said.

The CMS then said it would wait until July to release the star ratings, and it has moved forward despite a final push by those who oppose the star ratings in their current form.

Two U.S. representatives introduced a bill Monday to delay the release of the star ratings another year.

“I still have real concerns that this system could unfairly penalize teaching hospitals and hospitals that serve poor communities, and that patients will ultimately pay the price," said Rep. Kathleen Rice (D-NY), who co-sponsored the bill introduced Monday. She added that she was still working on the bill, which also contained a provision to rescind the ratings in the event they were published.

Rep. Jim Renacci (R-Ohio) also said he was disappointed by the release of the star ratings and reiterated concerns that they did not adequately reflect hospital performance.

Early in the month, hospital groups including the AHA, the Association of American Medical Colleges, America's Essential Hospitals and the Federation of American Hospitals wrote aletterto CMS' Acting Principal Deputy Administrator Dr. Patrick Conway, urging the agency to delay again.

"We urge CMS to share additional information with hospitals and the public about how accurately star ratings portray hospital performance," the letter said.

Goodrich stated in the blog post that the agency had conducted outreach to hospitals in an effort to assuage concerns.

"We continue to work closely with the National Quality Forum and the Assistant Secretary for Planning and Evaluation (ASPE), who is required by the IMPACT Act to study the effect of socioeconomic status on quality measures and payment programs based on measures," Goodrich wrote. She said CMS is open to adjusting the measures based on recommendations by the ASPE.

CMS currently uses star rating systems as quality indicators fornursing homes,Medicare plansanddialysis facilities. Some of those, too, were not without controversy. When CMS published the metric for nursing homes in 2009, industry groups pushed back. Later, an investigation of the system bythe New York Times found that many of the metrics that went into nursing home ratings were incomplete and sometimes misleading.