CMS to update hospital star ratings early next year despite blowback

By | August 20, 2019

UPDATE: August 19, 2019: The piece has been updated to reflect additional information from CMS and America’s Essential Hospitals.

Dive Brief:

  • CMS will update the oft-maligned hospital star ratings in early 2020 using the current methodology as they work on refining a new one, the agency said Monday. The star ratings have come under fire from providers for years, with hospital groups arguing they’re fundamentally flawed and should be disregarded altogether.
  • Simultaneously, the agency plans to release a proposed rule in 2020 permanently changing the methodology used to calculate the ratings, with the hopes of finalizing it before new star ratings are issued in 2021.
  • The American Hospital Association and America’s Essential Hospitals decried the decision. “Republishing the flawed ratings in 2020 will not advance the goal of providing the public with accurate, purposeful information about quality,” Ashley Thompson, AHA’s senior vice president of policy, said in a statement Monday, while AEH’s president and CEO Bruce Siegel said it was “misleading to patients” to publish ratings while the methodology is under review.

Dive Insight:

Hospital rankings are deeply controversial. Facilities are scored on a variety of metrics from patient satisfaction to mortality rates by a variety of ranking groups, from U.S. News to Leapfrog to the government itself. The outcomes vary widely and, as such, are a common target of provider ire as a bad rating can threaten brand, reputation and bottom lines.

Providers have slammed the Hospital Compare star ratings since its 2005 introduction for oversimplifying quality and being overly complicated for consumers to interpret. However, CMS refuses to abandon the program as the Trump administration and its healthcare regulators seek to inject more transparency and competition into the opaque U.S. healthcare system.

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The agency collects the data from its Hospital Quality Initiative programs, and the public can view the ratings on the Hospital Compare website, which ranks more than 4,000 Medicare-certified, Veteran’s Health Administration and military hospitals.

CMS last updated the star ratings late February — the first time the quality ratings have been refreshed since 2017 though they’re meant to be updated quarterly. Along with the update, CMS asked for public input on how it could simplify and streamline the system and received 800 comments from myriad stakeholders across the 30-day comment period.

The agency’s proposed changes are meant to improve precision by tweaking the computational method (called the latent variable model) and allow for direct, facility-to-facility comparison, such such as placing like hospitals into “peer groups” instead of weighing them against the entire pool.

“Importantly, few comments recommended removing or suspending the Overall Star Ratings from Hospital Compare until changes are made,” CMS said Monday.

But those recommending CMS suspend the ratings include powerful provider lobbies the American Hospital Association and America’s Essential Hospitals. The AHA accused the program’s methodology of being flawed from the outset and leading to “inaccurate, misleading comparisons of quality performance” in its comments submitted late March.

“While we appreciate that CMS is working on potential improvements to the rating methodology, we strongly believe CMS should not refresh the ratings until those improvements have been vetted and are ready for implementation,” AHA’s Thompson said.

AEH agreed, reiterating a common criticism that the ratings “fail to account for social risk factors beyond a hospital’s control that affect performance.”

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CMS will hold a public feedback session in Baltimore on Sept. 19 on the star ratings, and plans to work closely with a technical expert panel of roughly 15-20 members starting in the fall to shape the new methodology.

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