Healthcare groups, including the American Hospital Association (AHA) and the Association of American Medical Colleges (AAMC), are calling for major changes to how the federal hospital rating website Hospital Compare calculates its comparisons for consumers.
And until it does, those groups say, the site ought to be taken down.
Their calls come in response to a request last month from the Centers for Medicare & Medicaid Services to give feedback on ways to improve how it conducts ratings on the consumer comparison website that uses star ratings for hospitals to make the data more "precise and consistent" and make more direct "like-to-like" comparisons.
The data, collected through CMS’ Hospital Quality Initiative programs, includes specific quality measures, as well as the Overall Hospital Star Ratings.
"Unless and until the ratings methodology is improved, it will be difficult for hospitals and the public to have confidence that star ratings portray hospital performance accurately," the AHA wrote in its comments.
CMS launched the website in 2005 to make it easier for consumers to search for a hospital based on quality. But while the website has been lauded by consumer advocates, it has faced sharp criticism from the industry, which claims it misleads patients and is prone to errors.
Among the changes the groups say are necessary are an alternative approach to star ratings which would eschew an overall rating for ratings on specific clinical conditions or topic areas. Among their other comments:
- The AHA voiced support for CMS' proposed clinical and empirical criteria for creating and maintaining star rating measure groups using a statistical "confirmatory factor analysis" that would explore the extent to which there is a single factor that explains performance in the measure group.
- The groups both called for CMS to continue efforts to find ways to better compare hospitals in peer groups, pointing to hospitals with sicker and poorer patients having a tendency to fare worse on star ratings than other hospitals.
- The groups called for CMS to consider taking steps not addressed in its draft report including pulling together a small group of experts to examine and ensure its calculation approach is executed correctly and examine how it can mitigate the impact of outliers in calculating readmissions measures.
- They pointed to concerns about the use of PSI measures, which are otherwise known as patient safety and adverse event composites. That data is meant to provide an overview of hospital-level quality as it relates to a set of potentially preventable hospital-related events associated with harmful outcomes. The AHA has "long been concerned by the significant limitations of PSIs as a quality measure," the AHA wrote. "Claims data cannot and do not fully reflect the details of a patient's history, course of care and clinical risk."