CMS Releases 5-Star Hospital Quality Rankings

Hospital groups pan the 'deeply flawed' Hospital Compare ratings, which critics say unfairly penalize safety net hospitals and mislead consumers.

The Centers for Medicare & Medicaid Services on Wednesday unveiled its updated Overall Hospital Quality Star Ratings despite appeals for delay from the hospital industry.

"When individuals and their families need to make important decisions about healthcare, they seek a reliable way to understand the best choice for themselves or their loved ones," CMS Center for Clinical Standards and Quality Director Kate Goodrich, MD, said in a blog post accompanying the data release.

"Today, we are updating the star ratings on the Hospital Compare website to help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side-by-side, and ask important questions about care quality when visiting a hospital or other healthcare provider."

Goodrich said the new Overall Hospital Quality Star Rating methodology takes 64 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars.

"The rating includes quality measures for routine care that the average individual receives, such as care received when being treated for heart attacks and pneumonia, to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections," she said.

CMS said the Star Rating is based on questions such as:

• How often do patients get an infection after surgery?
• How long on average do patients have to wait in the Emergency Department before seeing a provider?
• How often do patients develop complications after hip replacement surgery?
• How likely are patients to get readmitted to the hospital after a heart attack?
• Will patients receive multiple CT scans or MRI's?

Of the nearly 4,599 hospitals that were graded:

• 102 (2.2%) received 5 stars;
• 934 (20.3%) received 4 stars;
• 1,770 (38.5%) received 3 stars;
• 723 (15.7%) received 2 stars;
• 133 (2.9%) received 1 star; and
• 937 (20.4%) received no ranking due to insufficient data.

The average Star Rating for teaching hospitals (mean = 2.87) was similar to, but slightly lower than that for non-teaching hospitals (mean = 3.11). 

Hospital Groups 'Disappointed'

Hospital groups had called on CMS to delay the release of the new ratings until it could address hospitals' concerns raised about the accuracy and correct use of the data. When CMS released the updated ratings on Wednesday morning, the critics pounced.

Rick Pollack, president and CEO of the American Hospital Association, called the ratings "confusing for patients and families" and "not ready for prime time."

"Healthcare consumers making critical decisions about their care cannot be expected to rely on a rating system that raises far more questions than answers. And it adds yet another to a long list of conflicting rating and ranking systems," Pollack said.

"We are especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor."

Pollack called on CMS to work with the hospital lobby and Congress to improve the ratings,

Association of American Medical Colleges President and CEO Darrell G. Kirch, MD, said the ratings give patients an incomplete picture of hospital performance.

"They are based on a deeply flawed methodology that does not take into account important differences in the patient populations and the complexity of conditions that teaching hospitals treat," Kirch said.

"As a result, many of the nation's leading teaching hospitals—institutions that provide the most advanced healthcare in the world—have been assigned lower ratings than other hospitals that treat patients with less complex conditions or that treat only certain conditions."

Kirch said that CMS's claims that the ratings measure hospitals on an equal basis is "unfortunately not true."

"Teaching hospitals perform a wide array of complicated and common procedures, pioneer new treatments, and care for broader socio-demographic patient populations that may not have access to regular care," he said. "Yet under the new ratings, they are compared directly to hospitals with more homogenous patient populations and hospitals that do not do enough procedures to be counted."

As a result, Kirch said, CMS used more than 60 measures to calculate ratings for teaching hospitals and as few as nine measures on some hospitals that treat patients with less complex conditions or that treat a limited number of conditions.

"AAMC analysis of the ratings has confirmed that the lower the number of measures a hospital reported, the more likely a hospital was to receive a higher star rating," Kirch said. "In fact, hospitals that reported on only 60% of the metrics or less received almost half of the five-star ratings."

Bruce Siegel, MD, president and CEO of America's Essential Hospitals, echoed those complaints.

"The star ratings exist partially in a black box, incorporate measures that miss clinically relevant data, and fail to adjust for patient circumstances that influence health and health care outcomes – circumstances outside a hospital's control," Siegel said. "Consumers deserve accurate, comprehensive, and relevant information to make health care decisions. Hospitals deserve to be evaluated on a level playing field. The star ratings accomplish neither."

CMS moved quickly to release the ratings after announcing on Monday that they would be released "shortly."