On July 27, 2016, the Centers for Medicare & Medicaid Services (CMS) released its newly created Overall Hospital Quality Star Ratings on its Hospital Compare website. The website enables individuals to compare overall ratings of up to three hospitals in their area at a time, which CMS says will help millions of patients and their families learn about the quality of hospitals.
Hospital quality information has been made available to the public on the Hospital Compare website since 2005, and hospital star ratings based on patient experience care data obtained from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey have been reported since April 2015. However, this is the first time that an overall quality star rating system has been applied to hospitals. CMS also provides compare websites for nursing homes, physicians, Medicare plans, dialysis facilities and home health agencies.
Hospital Compare provides ratings for over 3,600 hospitals on a one to five star scale, with one star representing the lowest rating, and five stars representing the highest rating. According to CMS, the star ratings were assigned as follows: 102 hospitals received five stars; 934 received four stars; 1,770 received three stars; 723 received two stars, and 133 received one star. The official data sets, including the overall star ratings, used on the Hospital Compare website is available to download at data.medicare.gov.
CMS published a data brief analyzing the distributions of the Overall Hospital Quality Star Ratings based on bed size, teaching status, safety net status, disproportionate share hospital (DSH) payment eligibility and critical access hospital (CAH) status. Although hospitals of varying bed size (classified as 1-99, 100-199 and 200+ beds) had similar average star ratings, smaller hospitals (1-99 beds) took home the most 5-star ratings. Teaching hospitals had lower average star ratings than non-teaching hospitals as did DSH payment-eligible hospitals as compared to non-DSH payment-eligible hospitals. CAHs had a higher average star rating than non-CAHs.
The single overall star rating is based on hospital performance in 64 of the 100 measures that are already posted on Hospital Compare and that are in part collected through the Hospital Inpatient Quality Reporting (IQR) Program and the Hospital Outpatient Quality Reporting (OQR) Program. These measures fall into seven groups of quality indicators: mortality, safety, readmission, patient experience, effectiveness of care, timeliness of care and efficient use of medical imaging. Some of these measure are based only on Medicare patient data (e.g., death and readmissions) while others are based on the hospital's general patient population (e.g., patient experience and safety)
In order to be rated, a hospital must meet minimum data threshold reporting requirements. Almost 1,000 hospitals on Hospital Compare were not rated because the hospital did not report enough data on all of the quality measures. In many cases, the lack of data may have been because the hospital was new or too small to have enough patients for the data to be significant enough for rating purposes. Maryland hospitals were not rated because, as part of their waiver agreement with Medicare, they are not required to report data on all of the quality measures to CMS.
CMS originally planned to release the Overall Hospital Quality Star Ratings back in April but delayed the launch after receiving complaints from hospitals and other stakeholders that the rating system did not take into account the socioeconomic status of the hospitals' patient populations. In a July 27, 2016 blog post for CMS, Kate Goodrich, MD, Director for Clinical Standards and Quality, reported that CMS conducted significant outreach and education to hospitals to respond to their concerns prior to publishing the data.
Since the release of the ratings, many hospitals and stakeholders continue to be concerned that the rating methodology is flawed and still does not effectively take into account the health and financial well-being of patient populations. Two days prior to the release of the star ratings, a bi-partisan bill (Hospital Quality Rating Transparency Act of 2016, H.R. 5927) was introduced in Congress by U.S. Reps. Jim Renacci (R-OH) and Kathleen Rice (D-NY) to delay the release of the Overall Hospital Quality Star Ratings for one year.
The star ratings will be updated quarterly, and CMS promises to work closely with hospitals and other stakeholders to enhance the Overall Hospital Quality Star Ratings based on feedback and experience.