102 hospitals will receive a five-star quality rating, CMS says

CMS' methodology called flawed by critics

CMS on Thursday said it plans to soon publish the first-ever overall hospital quality star ratings on its Hospital Compare website—and that few hospitals will receive a five-star rating.

The agency originally planned to release the overall hospital quality star ratings in April. However, CMS delayed the ratings' publication in response to providers' and lawmakers' concerns about the ratings' methodology.

For instance, American Hospital Association Senior Associate Director for Policy Akin Demehin said the methodology does not sufficiently adjust for factors shown to influence patient outcomes such as income, family assistance, and community support.

60 senators call on CMS to delay hospital quality star ratings

Earlier this month, hospital groups reiterated their concerns, saying CMS had not yet validated its methodology. However, other groups said CMS should not further delay the ratings' release. 

CMS previews ratings

CMS's preview of the distribution of overall hospital quality star ratings shows that out of nearly 4,600 hospitals:

  • 1,770, or 38.5 percent, will receive three stars;
  • 934, or 20.3 percent, will receive four stars;
  • 723, or 15.7 percent, will receive two stars;
  • 133, or nearly 3 percent, will receive one star; and
  • 102, or 2.2 percent, will receive five stars.

CMS did not assign star ratings to 937 hospitals because they did not meet minimum reporting thresholds required for the scores.

The data also show how ratings will be distributed based on various hospital characteristics.

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

According to the data, hospitals with one to 99 beds will have the highest percentage of five-star ratings, at 2.3 percent, while hospitals with 200 or more beds will have the highest percentage of one-star ratings, at 7.8 percent. The data show that 45.7 percent of hospitals with 100 to 199 beds will receive three stars.

In addition, the data show that the median star rating will be:

  • 2.92 for facilities eligible for disproportionate share hospital payments, compared with 3.47 for hospitals that are not eligible for such payments;
  • 2.88 for safety-net hospitals, compared with 3.09 for non-safety-net hospitals; and
  • 2.87 for teaching hospitals, compared with 3.11 for non-teaching hospitals.


CMS in a release said the data show that "hospitals of all types are capable of performing well on star ratings and also have opportunities for improvement."

However, Janis Orlowski, an executive at the Association of American Medical Colleges, said the data suggest CMS' rating methods are flawed and suggest that many reputable hospitals will receive poor ratings. "These are hospitals that everyone in the know tries to get into, so we need to be careful about the consequences, that this star rating can be misleading," Orlowski said, adding, "Putting the information out at this time is not in the patient's interest."

AHA SVP for public policy analysis and development Ashley Thompson said, "The data continu[e] to raise questions and concerns, as it may unfairly penalize teaching hospitals and those serving the poor. We urge CMS to work with the hospital field to ensure its methodology is fair and reliable, so that patients will have access to useful information."

Still, Debra Ness, president of the National Partnership for Women & Families, called on CMS to publish the ratings before the end of the month. She said, "When it is implemented, the Hospital Star Ratings program will help give consumers more meaningful information to guide their decisions about which hospitals to use," adding, "It's the kind of comparative information consumers are accustomed to using when they make other important decisions or purchases" (Whitman, Modern Healthcare, 7/21; Rau, Kaiser Health News, 7/22; Mangan, CNBC, 7/21; Lagasse, Healthcare Finance, 7/21; Punke, Becker's Infection Control & Clinical Quality, 7/21; AHA News, 7/21).

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