June 20, 2018

The Centers for Medicare and Medicaid Services (CMS) has postponed an update, originally slated for July, of the Overall Hospital Quality Star Ratings on its Hospital Compare website. The website is designed to serve as an information and decision-making tool for consumers, and is used as a resource by payers and providers as well.

CMS said it has decided to postpone publishing the new data “to give time for additional analysis of the impact of changes to some of the measures on the star ratings and to address stakeholder concerns. When changes are made to the underlying measures it is vital to take the time needed to understand the impact of those changes and ensure we are giving consumers the most useful information.”  The star ratings were last updated in December 2017, following a delay of the update that had originally been scheduled for July 2017.

Some providers and healthcare organizations, such as the American Hospital Association (AHA), have questioned whether the star rating system provides an accurate and reliable reflection of hospital quality and safety.  Some academic medical centers, for instance, contend that the ratings methodology does not fully weigh the impact of the sicker, more complex patient populations often treated at their institutions.

“Instead of providing useful information, the new ratings paint a confusing and conflicting picture of the quality of U.S. hospital care because of a deeply flawed methodology that ignores important differences in the patient populations and the complexity of conditions that different types of hospitals treat,” stated Darrell Kirch, president and CEO of the Association of American Medical Colleges, in an editorial.

An analysis by Rush University Medical Center in Chicago, reported in Modern Healthcare on June 15th, points to potential problems with the statistical model used to determine the star ratings. The ratings are calculated by weighting a hospital’s performance in mortality, safety, readmissions, patient experience, care effectiveness, care timeliness and efficient use of medical imaging.  The readmissions, safety and mortality outcomes groups each have a 22 percent weighting, as does performance in the patient experience category.

However, according to the Rush analysis, hospitals’ performance on one measure in the care safety category was used almost exclusively to determine the performance rating in that category. In addition, performance in this one group dramatically impacted hospitals’ overall star ratings, and this has been the case for every star ratings release since the system’s inception in 2016.

“Given the disproportionate weighting of the safety scores over time, they did not represent a composite measure,” Omar Lateef, MD, an author of the analysis and Rush’s senior vice president and chief medical officer, said in the Modern Healthcare article.

The AHA, a major critic of the star ratings system, said it supports CMS’s decision to delay the July release.  “We appreciate the agency allowing more time for a fuller analysis of its methodology and measures and to hear from stakeholders, including hospitals and health systems, about concerns found in many preview reports,” AHA Executive Vice President Tom Nickels said in a statement.

CMS has not yet said when the new ratings will be released.