MedPAC ques­tions ac­cu­racy of hospi­tal star-rat­ing sys­tem

Modern Healthcare - - NEWS - By Vir­gil Dick­son

The Medi­care Pay­ment Ad­vi­sory Com­mis­sion has added its in­flu­en­tial voice to those ques­tion­ing the ac­cu­racy of the CMS’ hospi­tal qual­ity star-rat­ing sys­tem and whether or not it pe­nal­izes hospi­tals with the sick­est pa­tients. The panel, which ad­vises Congress on Medi­care spending, will de­velop its own qual­ity mea­sures and a cor­re­spond­ing pay­ment struc­ture.

The CMS re­leased the ratings this sum­mer de­spite pres­sure from Congress and in­dus­try stake­hold­ers to de­lay or tweak the sys­tem. They and oth­ers say the sys­tem over­sim­pli­fies a com­plex mat­ter and could hurt hospi­tals’ rep­u­ta­tions.

The ratings are a com­pos­ite met­ric of one to five stars, with five be­ing the best, and are posted to the CMS’ Hospi­tal Com­pare site. The goal is to help in­form con­sumers’ choices on hospi­tals.

To gen­er­ate the ratings, the CMS uses as few as nine and as many as 64 mea­sures to gauge the over­all qual­ity of nearly 4,000 hospi­tals. The num­ber of mea­sures un­der­ly­ing the rat­ing de­pends on how many the hospi­tal is able to re­port on.

MedPAC an­a­lyzed the rat­ing sys­tem and found that of the 102 five-star hos- pitals, only 57 were rated on all out­come mea­sures, which in­clude mor­tal­ity, read­mis­sions, safety and pa­tient ex­pe­ri­ence. But nearly all of the 129 hospi­tals with a one-star rat­ing were rated on all the out­come mea­sures. On av­er­age, safety net hospi­tals earned slightly lower ratings, with a mean of 2.88 stars, than did non-safety net hospi­tals, which gar­nered an av­er­age rat­ing of 3.09 stars.

“The com­mis­sion is con­cerned that the cur­rent hospi­tal star-rat­ing pro­gram may not fully ac­count for the differences in the in­trin­sic health risks that pa­tients bring to the hospi­tals and there­fore may not pro­duce true ‘apples-to-apples’ com­par­i­son of hospi­tals,” MedPAC said in a let­ter sent to act­ing CMS Ad­min­is­tra­tor Andy Slavitt.

A CMS spokes­woman con­firmed that it re­ceived the let­ter and said the agency is draft­ing a re­sponse.

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