Doctor defends CMS' star rankings of hospital patient satisfaction scores

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Though some industry groups have criticized the Centers for Medicare & Medicaid Services' (CMS) recent rollout of a five-star scale to rank hospitals on patient experience, Ashish Jha, M.D., thinks the move is a sensible one that makes quality ratings far more consumer friendly, according to a post on the Health Care Blog.  

CMS' star rankings, already in use for consumer sites such as Nursing Home Compare and Physician Compare, compile data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to assign a star rating to hospitals that accept Medicare patients. About 7 percent of these hospitals received five stars under the new scale, and the bulk of facilities netted three stars, FierceHealthcare previously reported. The main advantage of the new rankings, according to Jha, is that they simplify what were disparate, difficult to understand care quality rankings that discouraged consumers' use of the Hospital Compare website.

To break down the rankings further, Jha, director of the Harvard Public School of Health, and analyst Jie Zheng linked CMS' hospital ratings to data on the structural characteristics of hospitals from the American Hospital Association's (AHA) annual survey. What they found wasn't surprising--small, for-profit, non-teaching and non-safety-net hospitals with large operating margins scored considerably higher on the five-star scale than their non-profit, teaching, safety-net counterparts.

While some people may take issue with the fact that small, higher-earning hospitals net most of the five-star ratings and large teaching hospitals that treat many low-income patients get very few, this doesn't necessarily signal a methodology problem on the part of CMS' rankings, Jha argues. Instead, "it may be that sicker, poor patients are less likely to rate their care highly," he writes. "Or it may be that the hospitals that care for these patients are generally not as focused on patient-centered care."

Though Jha also writes that HCAHPS scores also tend to correlate with other quality measures such as clinical outcomes, some have questioned this link, often pointing to research that challenges the notion that care quality and patient satisfaction go hand in hand. The AHA also took issue with the star rankings, noting that "there's a risk of oversimplifying the complexity of the quality of care," FierceHealthcare previously reported. CMS has indicated, however, that it will eventually expand the star ratings to include assessments of clinical outcomes and patient safety.

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