How CMS will decide if your hospital gets 'five stars' for quality

The agency says just 87 hospitals will receive five stars in April

CMS this week detailed the methodology behind its new overall hospital quality star ratings.

The first-ever overall ratings will appear in April on Medicare's Hospital Compare website and will complement existing metrics, such as the patient survey summary star rating.

Methodology details

According to CMS, the new star ratings are intended to make the site's data more user-friendly by providing "useful and easy-to-interpret" summaries.

The overall star ratings will be based on 62 quality measures from seven categories: effectiveness of care, efficient use of imaging, mortality, patient experience, readmissions, safety, and timeliness of care.  

CMS will analyze hospitals' performance and then use a clustering algorithm to assign hospitals a star rating on a one-to-five scale.

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CMS previews hospitals' performance

CMS said it plans to post overall ratings for 3,647 hospitals—out of 4,604 hospitals in the Hospital Compare dataset—that met reporting criteria. Under the new methodology, CMS said:

  • 87 qualifying hospitals (2.4%) earned five stars;
  • 821 hospitals (22.5%) earned four stars;
  • 1,881 hospitals (51.6%) earned three stars;
  • 716 hospitals (19.6%) earned two stars; and
  • 142 hospitals (3.9%) earned one star.

The agency said hospitals can confidentially preview their star rating via CMS's QualityNet portal.

American Hospital Association reaction

In a member advisory, the American Hospital Association (AHA) criticized CMS's new methodology, saying it "oversimplifies the complexity of delivering high-quality care" and should not be used. According to the association, measures of certain clinical services, such as cardiac care, provide better information for patients than one overall rating.

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AHA said, "The model assumes that one can make a generalized judgment about a hospital's overall quality using available measures, even if those available measures do not encompass all aspects of quality."

CMS said it collected feedback from a "broad array of stakeholders" to develop the new methodology (Rice, Modern Healthcare, 1/27; Green, Becker's Infection Control & Clinical Quality, 1/27; CMS methodology, 1/25).

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