No hospital quality stars today: Why CMS just delayed the new ratings

AHA 'commends CMS for its decision,' president and CEO Rick Pollack says

CMS on Wednesday announced it will delay publishing the first-ever overall hospital quality star ratings until July—at the earliest—in response to concerns from providers and lawmakers.

The patient survey summary star ratings currently on Medicare's Hospital compare website are based only on HCAHPS scores.

CMS said the new overall hospital quality star ratings, originally scheduled to be released on Thursday, would 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 said it would analyze hospitals' performance and then use a clustering algorithm to assign hospitals a star rating on a one-to-five scale.

In a preview issued by the agency in January, CMS said 3,647 hospitals—out of 4,604 hospitals in the Hospital Compare dataset—met reporting criteria and would receive an overall hospital quality star rating. Of qualifying hospitals, the agency said more than half would receive three stars, while only 87 (2.4 percent) would receive five stars.

The secret to Emory's jump in care quality? Teamwork.

Controversy

However, provider groups and lawmakers criticized the ratings methodology. The American Hospital Association (AHA) in January said it "oversimplifies the complexity of delivering high-quality care."

Last week, 60 senators sent a letter to CMS calling on the agency to delay the ratings' release. On Monday, 225 House lawmakers sent a similar letter, calling on the agency to "provide the necessary time to more closely examine the star rating methodology, analyze its impact on different types of hospitals, and provide more transparent information regarding the calculation of the ratings to determine accuracy."

Specifically, lawmakers expressed concern that hospitals treating a higher percentage of low-income or unhealthy patients would receive lower star ratings.

One prominent example of that concern, Steve Sternberg reports for U.S. News & World Report, is that the Cleveland Clinic—renowned around the world for its high-quality care—was set to receive an overall hospital quality star rating of only three stars.

The Clinic, which shared its CMS data with U.S. News, had a death rate that was significantly better than average, both in Ohio and nationally. However, the Clinic's readmission rate and patient-safety score were below average, which Anthony Warmuth, the Clinic's administrator for enterprise quality, says reflect in part the difficulty of adjusting quality data for the fact that the hospital treats the sickest patient population in America.   

AHA senior associate director for policy Akin Demehin echoes those concerns, arguing CMS does not sufficiently adjust for factors shown to influence patient outcomes such as income, family assistance, and community support. "Readmission measures are greatly affected by the economic status of patients the hospitals treat," he says.

CMS responds

CMS on Wednesday said it would delay the new ratings' release until July to gather stakeholder feedback and respond to "targeted concerns about specific calculations."

Agency officials also said they might delay the release further if they are still analyzing or changing the methodology, Jordan Rau reports for Kaiser Health News.

In a notice to Congress, CMS said the agency "is committed to working with hospitals and associations to provide further guidance about star ratings," adding, "After the star ratings go live in their first iteration, we will refine and improve the site as we work together and gain experience."

CMS also announced it will delay refreshing the current measures on Hospital Compare and releasing  new ambulatory surgical center and inpatient psychiatric measures until May 4. In addition, the agency said it will delay the start date for hospitals to begin previewing the July 2016 Hospital Compare data, originally scheduled for Friday, until May 6.

AHA President and CEO Rick Pollack says "the delay [of the overall hospital quality star ratings release] is a necessary step as hospitals and health systems work with CMS to improve the ratings for patients, and the AHA commends CMS for its decision." He adds, "We will continue to share our concerns with CMS as we look for ways to make changes to the ratings system, and ensure it is useful and helpful for patients" (Rau, Kaiser Health News, 4/20; Diamond, Politico Pro, 4/20 [subscription required]; AHA News, 4/20; Rice, Modern Healthcare, 4/20; Radnofsky/Armour, Wall Street Journal, 4/20; Punke, Becker's Hospital Review, 4/20; Sternberg, U.S. News & World Report, 4/20).

One key to improving your hospital's quality: Identify clinical variation

There are many opportunities to reduce care variation in hospitals today—but how should you prioritize those opportunities?

You should start by examining variation in two ways: "horizontal" and "vertical." A horizontal approach focuses on the use of costly resources across multiple conditions, while a vertical approach analyzes performance within a particular condition or patient population to develop a consensus-based standard.

Our infographic gives an example of each approach and explains the challenges of a horizontal approach versus the benefits of a vertical one.

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