Hospital star ratings lower as data includes COVID-19 fallout
As expected, this year's ratings look much like 2023, given the methodology has remained stable, AHA says.
Photo: John Fedele/Getty Images
Fewer hospitals earned 5 stars, and more received the lowest ranking of 1 star in the Overall Hospital Quality Star Ratings for 2024 released by the Centers for Medicare and Medicaid Services.
This year, 381 hospitals earned 5 stars, the highest ranking, while, in 2023, 483 hospitals received 5 stars. In 2022, 429 hospitals earned 5 stars.
For 2024, 766 received 4 stars, 828 got 3 stars, 595 received 2 stars, and 277 received 1 star.
This compares to last year's star ratings released in July 2023, when 803 hospitals received 4 stars, 872 got 3 stars, 668 earned 2 stars, and 250 got 1 star.
The overall rating shows how well each hospital performs on a set of quality measures compared to other hospitals nationwide. The results of individual hospitals can be viewed on the Hospital Care Compare website.
Hospitals are judged on 46 measures, sorted into five areas of quality, with each counting as 22% of the total score, except for timely and effective care, which counts as 12%. The quality areas rank hospitals on mortality, safety of care, readmission, patient experience and timely and effective care.
WHY THIS MATTERS
Unlike insurers which get bonuses for higher rankings in the Medicare Advantage Star Ratings, hospitals do not see a financial reward from CMS for earning 4 or 5 stars. Some individual hospital CEOs may have bonuses tied to higher stars, according to Dr. David Levine, chief medical officer for Vizient.
However, hospitals may face financial penalties in the form of a reduction to their market basket update for ratings that show a poor performance in such areas as hospital-acquired infections.
Most hospital executives pay attention to star ratings, and some use it as their primary North Star, Levine said. Vizient has its own scorecard rankings that it releases on a monthly basis.
The most recent Medicare Advantage star ratings also saw fewer health plans earning 5 stars when the rankings were released last October. The drop was deemed as the final fallout from COVID-19.
Hospitals are also experiencing the COVID-19 effect due to a data lag, according to Levine.
"Now we've hit the COVID years, especially '20 and 2021," he said.
The ratings data can be months or years old, and the lack of social risk factors, such as homelessness and access to follow-up care based on the hospital's location, can impact mortality and readmission measures, he said.
Vizient data shows that, nationwide, there were more harm events during the pandemic, such as hospital-acquired pneumonia and pressure ulcers.
Current data shows a trend towards improvement, Levine said.
What's affecting hospitals currently is a rise in patient acuity. Because so much care is now done on an outpatient basis, those who are admitted to the hospital are sicker, Levine said.
Recent earnings reports by the nation's top insurers bear this out. Most executives said their organizations were facing headwinds from higher utilization of services.
Another reason for a rise in patient acuity is that improvements in medicine have made it possible for people to live longer.
When he was practicing medicine 30 years ago, Levine said, patients who had certain cancers and chronic conditions, such as congestive heart failure or diabetes, were not living into their 80s. Today, patients with these conditions who are well into their 80s need more care.
THE LARGER TREND
Vizient, based in Texas, is a member-driven, healthcare-performance company known for its data and risk-adjustment services. It has more than 1,300 hospitals in its database.
ON THE RECORD
"As expected, this year's CMS Hospital Overall Star Ratings distribution looks largely like 2023 given that the methodology that hospitals are rated on has remained stable for the last few years," said Akin Demehin, AHA senior director of quality and patient safety. "Multiple factors could contribute to a hospital experiencing a shift in ratings, including changes to underlying measures used to calculate the ratings, the time periods used to calculate performance and minor coding changes. This year's ratings also continue to include data reflecting the profound effect the COVID-19 pandemic had on hospital operations."
Email the writer: SMorse@himss.org
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