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Controversy Surrounds Release of New CMS Hospital Star Ratings

WASHINGTON, DC – Despite strong opposition from the hospital industry, the Centers for Medicare & Medicaid Services (CMS) recently released its new star ratings for hospitals on its Hospital Compare website.

The new Overall Hospital Quality Star Rating summarizes data from existing quality measures publicly reported on Hospital Compare into a single star rating for each hospital, which CMS touts as an upgrade that makes it easier for consumers to compare hospitals and interpret complex quality information. The agency said the overall rating supplements the more specific star ratings currently posted for hospitals on patient experience data derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The patient experience of care hospital star ratings were first publicly reported in April 2015.

While CMS maintains that the new ratings “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 healthcare provider,” the American Hospital Association strongly disagrees.

“The new CMS star ratings program is confusing for patients and families trying to choose the best hospital to meet their healthcare needs,” responded AHA President and CEO Rick Pollack. “Healthcare consumers making critical decisions about their care cannot be expected to rely on a rating system that raises far more questions than answers. And it adds yet another to a long list of conflicting rating and ranking systems … We want to work with CMS and the Congress to fix the hospital star ratings so that it is helpful and useful to both patients and the hospitals that treat them.”

Earlier this month, the AHA and other industry groups urged CMS to share additional information with the healthcare industry and the public about how accurately the overall hospital quality star ratings portray hospital performance. They also asked the federal government to either work with hospitals to validate the methodology or continue to withhold publication of the ratings.

The AHA said its concerns about the flawed data are based on an analysis by an independent expert.

Release of the ratings were delayed in April after a bipartisan majority of both houses of Congress urged that action, asking CMS to work with the hospital field to ensure the ratings are fair and reliable.

CMS maintains in a press release that it met all of those objections, noting, “Today’s update comes after substantive discussions with hospitals and other stakeholders to review the Overall Hospital Quality Star Rating’s methodology.”

Kate Goodrich, MD, MHS, Director of Center for Clinical Standards and Quality, said in a blog that, during the delay, the agency conducted significant outreach and education to hospitals to understand their concerns and directly answer questions.

Star ratings are based on 64 individual measures, including death, infection rates, and patient reviews, and CMS said specialized and "cutting-edge care," such as the latest cancer treatments, were not reflected in the ratings.

The rating system has been criticized for penalizing hospitals that treat patients with low socioeconomic status or multiple complex chronic conditions. The result is that some of the most highly rated hospitals performing complex procedures and treating the sickest patients often are ranked low on the five-star scale.

In fact, just 102 hospitals received the top rating of five stars, and that list didn’t include some of the institutions receiving highest ratings elsewhere, such as Massachusetts General Hospital in Boston, which was at the top of U.S. News & World Report’s Honor Roll of Best Hospitals.