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Where hospitals fared best in CMS's new five-star ratings

April 20, 2015

    Juliette Mullin, senior editor

    Last week, CMS caused quite the stir when it introduced a new ratings system for hospitals, this one using a five-star scale to evaluate hospitals on patient experiences.

    About the new ratings

    The new ratings—on the Hospital Compare website—are part of a broader effort to offer star ratings on all of CMS's consumer-facing Compare websites.

    Medicare first began using star ratings in 2008, when it applied them to nursing homes. In the past year, it has implemented similar programs for home health providers, dialysis facilities, and large group practices. According to Modern Healthcare's Sabriya Rice, the rollouts were met with controversy over the methodology and debate over whether the ratings added or eliminated confusion for patients.

    The hospital rating system offers a star rating based on the 11 publicly reported measures in the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which assesses patient experiences. This year's ratings evaluated patient experiences from July 2013 to June 2014.

    In total, Medicare awarded five-star ratings to 251 of the 3,553 eligible hospitals—or about 7% of the nation's hospitals. In addition:

    • 1,205 hospitals, about 34%, received four stars;
    • 1,414 hospitals, about 40 %, received three stars;
    • 582 hospitals, about 16% received two stars; and
    • 101 hospitals, about 3%, received one star.

    Medicare did not rate 1,102 hospitals, because it lacked adequate patient experience data during the survey period.

    CMS unveils new five-star ratings. How did your hospital fare?

    Where hospitals fared best

    Hospitals in certain states appeared to perform better on the CMS ratings than others, Jordan Rau reports for Kaiser Health News. His analysis of the data finds that hospitals in three states received an average rating of four stars or more:

    • Maine (with an average of 4.1 stars);
    • South Dakota (4.1 stars); and
    • Wisconsin (4 stars).

    Meanwhile, hospitals in several states received an average rating below three stars:

    • District of Columbia (2 stars);
    • Florida (2.7 stars);
    • Maryland (2.4 stars);
    • Nevada (2.4 stars);
    • New York (2.5 stars);
    • New Jersey (2.6 stars);
    • California (2.7 stars);
    • New Mexico (2.8 stars)
    • Connecticut (2.9 stars).

    Hospitals push back

    However, hospital officials warn that the scores can be misleading. 

    "The reasons that patients seek care from hospitals are varied," says Akin Demehin, the American Hospital Association's senior associate director of policy. He explains, "We are not confident that a star-rating approach—especially one that would encompass all of the measures on Hospital Compare and roll them up into a single overall star rating—is going to give patients the insight on the quality of their hospitals that CMS is hoping for."

    Some facilities that received low ratings—about 3% of hospitals got just one star—say that CMS should have used more current data to reflect recent efforts to improve care quality and patient experiences.

    Modern Healthcare notes that specialty hospitals performed especially well on the ratings. In fact, more than 60 of the 250 hospitals that received five stars were specialty facilities. Experts argue that it may be easier for such hospitals to boost patient satisfaction performance because of their size and narrow focus.

    Want to please patients? Maybe you should start a specialty hospital.

    In addition, analysis by Harvard's Ashish Jha and his team found that large, not-for-profit teaching hospitals located in the northeastern and western parts of the United States performed significantly worse on the ratings than small, for-profit facilities in the South and Midwest. "The differences were big," Jha writes, explaining, "There were 213 small hospitals (those with fewer than 100 beds) that received a 5-star rating. Number of large hospitals with a 5 star rating? Zero."

    Here's the full breakdown of the ratings by hospital type done by Jha and his colleagues:


    But ultimately, Lisa Allen, the chief patient experience officer at Johns Hopkins Hospital, argues that the star ratings may help increase providers' focus on patient-centered care. "Everybody is paying attention to this now," she told Modern Healthcare's Sabriya Rice, adding, "And that's a good thing."

    From our expert: How to think about hospital rankings

    The glut of ratings raises two questions. First, is anyone paying attention—beyond largely ambivalent hospital executives?

    And second, how much should hospitals care about these rankings?

    In an interview with the Daily Briefing's Clare Rizer, the Marketing and Planning Leadership Council's Alicia Daugherty discussed the Advisory Board's research on rankings, addressed some of the criticism that these systems have received, and touched on whether a good rating can lead to a return on investment (ROI).


    How we can help

    The Advisory Board offers myriad resources to help you improve patient experience, including:

    • Ensure excellence for every patient, every day. Creating a positive patient experience builds loyalty—and loyalty could mean nearly $3 million of revenue potential for a typical hospital. Our technology helps you improve the patient experience by gathering satisfaction data in real time while automatically disseminating service recovery requests and providing intelligent dashboards.
    • Why so many patient experience efforts fail. We know the causes of failure for patient experience initiatives, and we have a data-driven, closed-loop approach that has led to more than 40% increases in HCAHPS rankings in patient experience.

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.