Problems with the structure and execution of the Centers for Medicare & Medicaid Services (CMS) star ratings are so serious that CMS should halt their use until repairs can be made, according to a letter sent by the American Hospital Association (AHA) to the government agency.

The AHA was responding to a request for comment on 12 potential changes to the star ratings methodology. It argued that only these three proposals should be pursued further: empirical criteria for measure groups, peer grouping star ratings among similar hospitals, and “explicit” scoring.

“The remaining proposals either fail to address important shortcomings with star ratings, or simply do not have enough information for us to judge their impact,” the AHA letter says. “We believe it is important that these steps be taken prior to considering implementation of any other changes to the star ratings.”

The AHA suggests that CMS should convene a small group of experts on latent variable models, study how to mitigate the impact of outliers in readmission rates, and develop an alternative to hospital ratings that instead provides ratings on specific clinical conditions.

“Lastly, we continue to urge CMS to remove the existing star ratings from Hospital Compare while its important work of improving the methodology continues,” the AHA letter says. “We appreciate the desire for the ratings to reflect the most current quality data. Yet CMS’s public comment underscores the many problems with the current methodology. Unless and until the ratings methodology is improved, it will be difficult for hospitals and the public to have confidence that star ratings portray hospital performance accurately.”

The full letter is available online at: