Is CMS listening to hospital leaders, when it comes to hospital quality ratings? And where is that entire train headed? As Managing Editor Rajiv Leventhal noted in a March 1 report, “The Centers for Medicare & Medicaid Services (CMS) has updated hospital performance data on its Hospital Compare website, and for the first time in more than a year, the agency has also updated its overall hospital star ratings. This hospital compare data, according to Medicare officials, includes specific measures of hospitals’ quality of care, many of which are updated quarterly; the star ratings data was last updated in December 2017. The data is collected through CMS’ Hospital Quality Initiative programs.”
As Leventhal explained, “The overall hospital quality star ratings, on a one-to-five scale, are designed to help individuals and caregivers compare hospitals in an understandable way.” And his report included a quote from CMS Administrator Seema Verma, who said in a statement on Mar. 1 that “The Hospital Compare website and star ratings system are valuable consumer tools that provide helpful and important information on the safety and quality of our nation’s hospitals. These decision-making tools offer greater transparency on hospital performance for a wide variety of users—patients, caregivers, families, and the broader healthcare industry,” Verma said on Friday, in making the announcement about Hospital Compare and the star ratings system.
Yet despite the happy-faced commentary from Administrator Verma, all is not blissful in Quality Ratings Land. For, even as CMS officials are working on making changes, and have posted potential changes to the hospital star ratings program for comment, with the changes under consideration aimed at making hospital comparisons more precise and consistent, they’re getting fairly major blowback about both Hospital Compare and the star ratings system, from the American Hospital Association (AHA), the hospital industry’s main representative association. On Thursday, immediately after CMS’s announcement, the AHA released a statement attributed to executive vice president Tom Nickels. “America’s hospitals and health systems have long supported transparency on quality and safety data because patients and their families need clear, useful information to make health care decisions,” Nickels said. “However, CMS’s approach to star ratings has been flawed from the outset. Today’s update has not addressed the major concerns about the methodology and usefulness of the star ratings. That is why the AHA asked CMS to postpone its publication until concerns about the methodology could be remedied. We appreciate that CMS continues to seek comment on changes, but would have preferred the agency had waited to release these ratings until a more reliable methodology is in place. We remain committed to working with CMS on our shared goal – providing the public with accurate, purposeful information about quality.”
Indeed, the problems that hospital leaders have been complaining about are far from new, and go back to CMS’s first release of hospital ratings in the summer of 2016. As Leventhal noted in his report on Friday, “[T]he AHA and others feel the methodology that determines the star ratings for hospitals is severely flawed. A few years ago, a Kaiser Health News report dug into the ratings, revealing that just 102 of the more than 3,600 hospitals that CMS rated received the top rating of five stars, while Medicare gave its below average score of two-star ratings to 707 hospitals, including some of the most prominent and well-renowned organizations in the country such as Geisinger and MedStar.”
In fact, in that July 27, 2016 article, Kaiser Health News’s Jordan Rau interviewed numerous disgruntled hospital executives. One, Steven Lipstein, the president of BJC HealthCare, which runs Barnes-Jewish Hospital and a 13 others, told Rau that Medicare had awarded between two and four stars to the system’s hospitals, even though they all “employ the same standards, the same methodology, the same clinical guidelines.” The major difference, he said, was the comparative affluence of the patients each served, with poorer scoring hospitals located in lower income areas. “The stars tell you more about the socio-demographics of the population being served than the quality of the hospital,” Lipstein told Rau in that interview.
So, where do we go from here? As Leventhal noted in his report on Friday, “The changes under consideration aim to enhance the star ratings methodology by making hospital comparisons more precise and consistent, and by allowing more direct, “like-to-like” comparisons, according to agency officials. One potential change, for instance, recommended by some hospitals, would place hospitals with similar characteristics into “peer groups” allowing, for example, small hospitals to be compared to other small hospitals instead of all hospitals, CMS said.”
That, for one, would represent a huge leap forward. Right now, as hospital executives noted in their comments in the Kaiser Health News report, the Hospital Compare program and its star ratings system are viewed as fundamentally flawed, by hospital executives. What’s more, there are so many privately sponsored rankings systems out there, themselves riddled with methodological and presentation flaws, that it honestly is deeply confusing to healthcare consumers on a broad level.
Fundamentally, CMS has both a responsibility to provide healthcare consumers with useful data and information for making informed choices in selecting healthcare services, and also an opportunity—if that opportunity is fully grasped. Ironically for an administration that constantly talks about empowering free-market consumerism, CMS’s timid approach to a program that has long been dismissed out of hand by most hospital and health system executives, comes across as weak tea indeed. Perhaps Administrator Verma could sponsor a working group to engage with hospital leaders, and could convene a process that might reengineer the entire Hospital Compare and star ratings system, to make the process, and the data, more meaningful and useful to everyone. Doing so would not only create engagement with the hospital leadership community nationwide; it might also ultimately improve patients’/consumers’ ability to make the kinds of informed choices that Verma keeps talking about as a foundation for the market competition based on value, that she believes in. It’s all connected, but right now, things in this area remain, at least perceptually, something of a foggy muddle. Here’s hoping.
