The Trump administration will finalize an update of its quality measurement methodology for its Overall Hospital Quality Star Ratings in 2021.
In the meantime, officials said, they will "refresh" the Star Ratings on its Hospital Compare website in early 2020.
While the Centers for Medicare & Medicaid Services (CMS) said it has "full confidence in their accuracy and reliability," it also "routinely" refines the methodology used to calculate them to ensure they are as "helpful as possible." "CMS is empowering patients to make informed healthcare decisions, leading providers to compete on the basis of cost and quality," CMS Administrator Seema Verma said in a statement.
Hospital Compare rates hospital quality on a scale from one to five stars. CMS last updated the ratings this spring. At the time, healthcare groups including the American Hospital Association (AHA) called for major changes to how the federal hospital rating website calculates its comparisons for consumers and called for the site to be taken down until the changes are made.
- Removal from the web: The AHA, the Association of American Medical Colleges, Advocate Aurora Health, Ohio State University Wexner Medical Center, Zuckerberg San Francisco General Hospital and Trauma Center, Benefis Health System, the Healthcare Association of New York State, the Wisconsin Hospital Association and Tampa General Hospital were among health systems and associations to call for the current star ratings to be removed from the Hospital Compare website "given the hospital industry’s outcry against the Star Rating system, combined with the lengthy and technical nature of CMS’ recently issued report outlining significant potential changes to the system."
- Specific methodology changes: Officials at several health systems, including John Jay Shannon, CEO of Cook County Health, called for CMS to rethink its latent variable model to make it more "transparent and predictable." Rush University Medical Center said it believed four specific changes would help address concerns it has with the Star Ratings. "First, aligning adjustment for Socioeconomic status in the Stars program to that of the [Hospitals Reduction Readmissions Program] would be a logical and consistent method for measuring quality. Second, capping the impact of volume on adjustment and incorporating confidence intervals would address issues with volume impacting rates," the center wrote.
"Third, removal of the impact of outlier readmissions on the readmission measure would eliminate the undue influence of individual patients on rates and, we speculate, reduce the risk of adverse outcomes due to unintended consequences of the policy. Finally, abandoning the latent variable model in the composite rating for the Overall Rating would address its lack of consistency."
Grouping concerns: Officials at several organizations took issue with grouping hospitals of different sizes or with populations facing different levels of social determinants challenges. "There is something fundamentally flawed about [a] system in which the small community hospital with minimal services available is the highest-rated hospital in our region and the academic medical centers and safety-net hospitals look poor in comparison," said Pat Reagan Webster, associate quality officer at Strong Memorial Hospital and an associate professor of public health sciences at the University of Rochester. University of California Health System Executive Vice President John Stobo, M.D., said the health system does "not believe the public can benefit from accessing CMS's Hospital Compare Star Ratings unless and until the methodology being used to evaluate hospitals more fully accounts for the distinct functions and patient populations characteristic of academic medical centers."
They also suggested changes to the subsets of measurements used. "A better approach would be to provide a subset of measures than one composite score or in addition to the composite score. Such a subset would be more useful for patients making decisions and would help better direct quality improvement efforts at the hospital level," said Jennifer Carlson, associate vice president for external relations and advocacy at the Ohio State University Wexner Medical Center.
The public comments will inform the methodology that CMS plans to ultimately propose in rule-making in 2020. CMS is planning a public listening session on the Star Ratings for a range of stakeholders in Baltimore Sept. 19 that will include a call-in option, officials said.