CMS releases controversial overall star ratings on hospital quality

The Centers for Medicare and Medicaid Services on Wednesday  released its star ratings for individual providers on its Hospital Compare website.

Last week, CMS said 102 hospitals earned five stars in its update, while 934 scored four stars; 1,770 three stars; 723 two stars; and 133, one star.

The analysis shows that all types of systems have both high performing and low performing hospitals, according to a blog released Wednesday by Kate Goodrich, M.D., director of Center for Clinical Standards and Quality for CMS.

Researchers found that hospitals with more stars on the Hospital Compare website tended to have lower death and readmission rates, she said.

[Also: Renacci, Rice introduce bill to delay Overall Hospital Star Ratings for one more year]

CMS had delayed the release of the star ratings due to concerns from providers over the methodology used and in particular, what providers said was CMS's failure to account for the sociodemographic characteristics of the patients they serve.

In April, 60 U.S. Senators added their voices by sending a letter to Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt asking him to delay the release of the rankings until CMS could include factors for patients' income-level and other socioeconomic indicators.

In her blog, Goodrich said CMS subjected the measures used to calculate the overall hospital quality star rating to rigorous scientific review and risk adjustment.

The star ratings are based on clinical guidelines and are endorsed by the National Quality Forum, Goodrich said.

[Also: 102 hospitals will earn 5 stars in new Overall Star Ratings, CMS says]

"Most of these quality measures are already adjusted for clinical co-morbidities to account for the illness-burden of the population," she said. "We continue to work closely with the National Quality Forum and the Assistant Secretary for Planning and Evaluation, who is required by the IMPACT Act to study the effect of socioeconomic status on quality measures and payment programs based on measures."

CMS failed to address concerns from both the hospital community and Congress, said Darrell G. Kirch, MD, president and CEO of the Association of American Medical Colleges.

Teaching hospitals are getting lower ratings because they treat patients with complex conditions and pioneer new treatments, he said.

"Patients should beware of making decisions about hospitals using the newly released star ratings," Kirch said in a statement released Wednesday. "They are based on a deeply flawed methodology that does not take into account important differences in the patient populations and the complexity of conditions that teaching hospitals treat."

CMS used more than 60 measures to calculate ratings for teaching hospitals and as few as nine measures on some hospitals that treat patients with less complex conditions or that treat a limited number of conditions, he said. AAMC analysis of the ratings has found that the lower the number of measures a hospital reported, the more likely a hospital was to receive a higher star rating. Hospitals that reported on only 60 percent of the metrics or less received almost half of the five-star ratings, Kirch said.

CMS will work with the Assistant Secretary for Planning and Evaluation to determine what next steps, if any, should be taken to adjust the measures based on recommendations expected in a report, according to Goodrich.

The star ratings rank quality of care in five different healthcare settings, from hospitals to nursing homes and home health agencies.

[Also: Hospital groups accuse CMS of ignoring concerns over Hospital Compare star ratings]

The new overall hospital quality star rating methodology takes 64 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars.

The rating includes quality measures for routine care that the average individual receives, such as care received when being treated for heart attacks and pneumonia, to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections.

Specialized or cutting edge care that certain hospitals provide such as specialized cancer care, is not reflected in these quality ratings, Goodrich said.

While CMS delayed the release of the most recent ratings, it conducted significant outreach and education to hospitals to understand their concerns and directly answered their questions, she said.

This included two national provider calls with over 4,000 hospital representatives to walk through the methodology, and holding numerous meetings with hospital associations and individual hospitals.

The star rating will be updated quarterly, and will incorporate new measures as they are publicly reported on the website as well as remove measures retired from the quality reporting programs, Goodrich said.

"Today, we are taking a step forward in our commitment to transparency by releasing the Overall Hospital Quality Star Rating," she said. "We have been posting star ratings for different facilities for a decade and have found that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries."

The star rating are part of the administration's Open Data Initiative.

Twitter: @SusanJMorse