CMS star ratings: Response plan for high- and low-ranking hospitals


Like it or not, the Centers for Medicare & Medicaid Services has released its star ratings and the lowest-ranking hospitals will have to deal with the fallout. But that doesn’t mean five-star hospitals can rest easy-- because the bar for quality just became higher.

“I think that it’s important that all organizations regardless of the score and how they view the scoring mechanism take this seriously,” Rita Numerof, Ph.D. (pictured right) president of healthcare management consulting firm Numerof & Associates, told FierceHealthcare in an exclusive interview.

Some hospitals will celebrate their success today; others must acknowledge their failure. But all, Numerof says, must undertake a thorough analysis of the results to understand the ratings and also determine what must change in order to improve their practices.

For example, she says, the 102 hospitals that received five stars must consider that the rankings aren’t based on current data, and therefore, leaders must determine whether the organization has maintained that level of excellence. Leaders, she adds, must ask whether the results would be the same if CMS were to analyze their most recent data.

“An objective, disciplined analysis that critiques the data and drills down into specifics will build a culture of accountability of excellence that starts at the top and permeates through the rest of the organization,” she says.

And, she says, high-ranking hospitals will be under pressure to not only maintain their scores but must also aim to improve it. “This expectation of service just increased a little bit,” Numerof says, adding that if these high-ranking hospitals don’t take steps to continue to improve, their ratings may not look as good a year from now as lower-ranking hospitals take actions to improve their scores.

Numerof, an occasional blogger for FierceHealthcare’s sister publication Hospital Impact, also notes that the ratings are based on a comprehensive set of measures and CMS has noted that they may change over time. “In that sense they are a moving target,” she says.

Nearly 40 percent of hospitals will receive a three-star rating, but close to 20 percent of the nation's hospitals will receive either two stars or one star. 

The release of the rankings should serve as a “wake-up call” for everyone who works for these low performing hospitals. Numerof says that in order for these organizations to succeed, they must fundamentally change the way they do business.

“There will be an emotional reaction internally at every level of the organization,” she says. “There will be a sense of real dismay and often a sense of failure, anger and frustration as all individuals in the organization are confronted with news that shows a discrepancy from the work they thought they were doing.”

Most healthcare workers don’t intentionally create harm and try to do right by their patients. “They will react personally to real and perceived failure so this information is likely more devastating within the organization than outside the organization,” she says.

But, she warns, it would be a mistake for failing hospitals to bash the measures. While the measures aren’t perfect--many hospital industry leaders complain that they don't provide an accurate picture of quality because they don't take into account socioeconomic and demographic factors of vulnerable patients--organizations have long known what metrics would be evaluated.

Despite attempts to continue to delay the release of the data, CMS today said that it has continued to work with hospitals to discuss the measures and answer any questions they had. 

The worst approach to take, she says, is to blame the system or deny or rationalize poor results.

“Executives need to communicate and acknowledge that they are fundamentally disappointed but they are committed to safety and quality and they will reevaluate their own practices and instill more discipline so there is not a repeat going forward," says Numerof, co-author of the book, “Bringing Value to Healthcare: Practical Steps for Getting to a Market-Based Model.”

The commitment to improve can rally the entire organization and will be vital to its future success. There must be a sense of accountability for zero defects or there won’t be a change in practice, she says.