Hospitals in more 'stressed' cities have worse CMS star ratings, study finds

Ratings have "less to do with what the hospitals themselves are doing and more to do with the communities they are located in," expert says

The socio-economic status of a hospital's location significantly influences its CMS quality ratings, according to a study published Monday in JAMA.

CMS' overall hospital quality star ratings, published on Medicare's Hospital Compare website, are based on 64 quality measures grouped under three process categories—effectiveness of care, efficient use of medical imaging, and timeliness of care—and four outcomes categories—mortality, patient experience, readmissions, and safety of care.

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For the study, researchers used data from a 2016 WalletHub analysis that ranked the most and least "stressed" cities in the United States based on socio-economic conditions, such as unemployment rates and poverty rates. The researchers then averaged the star ratings for all hospitals located in each of the 150 cities included in the analysis. Overall, the researchers analyzed 657 hospitals with star ratings.


The researchers identified a correlation between overall stress levels and hospital star ratings in each city. They found hospitals with low star ratings typically were located in cities with high stress levels.

For example, hospitals in Detroit, which had the highest stress level, on average had 1.5 stars, and those in Newark, New Jersey, which had the ninth highest stress level, on average had one-star ratings.

In comparison, hospitals in Fremont, California, which had the lowest stress level, on average had three stars. Hospitals in Irvine, California, which had the second-lowest stress level, had an average of five stars.

Study co-author David Nerenz, director of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit, said the results were not surprising.

"When we look at hospital quality ratings and rankings, what we are seeing has less to do with what the hospitals themselves are doing and more to do with the communities they are located in and the patients they serve," he said.

Nerenz said that quality ratings should account for factors like transportation and social support programs because they can affect readmission rates and other quality metrics.

"If we're going to present hospital quality to the public, the goal is to be as precise as possible," he said (Castellucci, Modern Healthcare, 11/28; Greene, Crain's Detroit Business, 11/28).

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