Hospital Impact—Refreshing the conversation on CMS Star Ratings might help fix what Congress can’t

quality
Without a consistent and transparent metric for evaluating their choice of providers, patients have little reliable information to make decisions about where to go for care.
Rita Numerof
Rita Numerof

With the Affordable Care Act seemingly impervious to congressional Republican majorities, the time has come to use limited federal regulatory authority to bend the curve toward a market-based, patient-centered approach to healthcare.

Unfortunately, the recent postponement of updates to the Centers for Medicare & Medicaid Services’ Star Rating system is a step in the wrong direction.

Giving consumers real market power demands a transparent view of provider performance. When patients stay informed, providers stay on their toes—and that’s a good thing. The CMS Star Ratings aren’t perfect, but they put institutional accountability back on the table and real choice back in the hands of consumers.

The ratings evaluate provider performance across a variety of metrics, condensing the results into a single score. They offer the potential for patients and their loved ones to compare nearby facilities side-by-side, giving them the knowledge to ask important questions about their treatment, the process it is likely to follow, the costs they can anticipate, and the outcomes they can expect.

Michael N. Abrams
Michael N. Abrams

While the ratings were initially intended for quarterly updates and revisions, officials have stymied attempts to roll out a fresh review since July 2016. Just prior to Tom Price’s resignation from his post as Health and Human Services secretary, his department announced yet another push to delay the release of new ratings.

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Though Price, a practicing physician, took a hard line against the ratings rollout, his potential successors may be more willing to revisit discussions on the system’s efficacy. Chief among them is CMS Administrator Seema Verma, whose work with Medicaid looked to combine institutional accountability with patient-centered care. It now seems that there may be a fresh opportunity to reopen the conversation on new ratings.

Since the ratings summarize 64 quality metrics within a single score, it’s easy to see why critics have blasted CMS for trying to boil down a broad range of measures into what many believe is an oversimplified rating. But it’s also important to recognize that the system was created to evolve over time.

CMS has always said it intends to improve; letting providers blame the rating system for their own shortcomings serves no useful purpose. Even if the scoring is far from perfect, it still has value. To date, it’s proven the most effective way of getting hospitals to develop more meaningful accountability measures and improve their overall quality of care.

Take, for instance, the concerns that providers raised when scores were released last year. Though they protested about inaccurate coding and improperly applied risk stratification, institutions still scrambled to clean up their own internal tracking methods. It became clear that insiders’ anxieties had little to do with CMS being too clumsy with its data. Instead, more aggravating to the industry was that it had finally been forced to improve its own outdated systems.

RELATED: Analysts say hospital rankings, including CMS' star system, confusing at best, misleading at worst

Patients benefitted from the initiatives hospitals were finally compelled to take, creating a more streamlined path to higher-quality care. With just the right amount of oversight, Star Ratings had provided institutions with accountability and consumers with transparency.

With higher copays and deductibles, patients have increasingly more “skin in the game.” But without a consistent and transparent metric for evaluating their choice of providers, there’s little reliable information to make decisions about where to go for care.

As the country’s largest payer, CMS should be commended when it takes bold steps in connecting the payments it makes to actual health outcomes. We’re still a long way away from the market-based healthcare system we genuinely need. But refusing to take the first step stagnates industry progress and keeps consumers stuck in the dark.

Working in partnership, the industry and its regulators now have an opportunity to discuss what demands revision within the current system. Instead of simply showing patients a singular score, for instance, CMS might illuminate the disparate components of a hospital’s composite rating. And rather than try to eliminate statistical outliers to normalize data sets, CMS could retain those examples of providers who strive for excellence, along with those who need to improve upon serious safety and quality defects.

CMS ratings force critically needed discussions about quality, cost and outcomes. Returning to these conversations means giving consumers a voice in demanding value-based care on which they can rely.

Rita E. Numerof, Ph.D., is president and Michael N. Abrams is managing partner of Numerof & Associates, a firm that helps businesses across the healthcare sector define and implement strategies for winning in dynamic markets.