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Critics of Medicare’s Hospital Star Rating Push for Changes

Industry leaders give “thumbs down” to patient-friendly quality indicator

During the past decade, the federal government has proposed 115 different ways to measure medical quality in hospitals, from assessing wait times in emergency rooms and noise levels outside hospital rooms to tracking blood clots in surgical patients. But the latest effort, to combine dozens of metrics into one patient-friendly quality indicator, has proven the most contentious, according to Kaiser Health News.

The Centers for Medicare and Medicaid Services recently postponed its plan to release the new rating system, which would award one star to the worst-quality facilities and five stars to those with the best marks. The delay came after a majority of members of Congress signed a letter supporting the hospital industry’s concerns.

Hospital leaders who previewed the preliminary rating system say the formula seems skewed against institutions that treat the poorest or toughest patients, meaning those with complex illnesses. The number of stars would be based on 64 different measures, which are posted on Medicare’s “Hospital Compare” website. The metrics on mortality, readmission, patient experience, and patient safety are the most influential, each representing 22% of a facility’s rating.

Consumer advocates defend the rating system, saying that while not perfect, it correctly reflects higher rates of problems in some big institutions despite their lofty reputations. They worry that delay and congressional resistance are undermining Medicare’s attempt to help consumers select a hospital based on something more substantive.

Medicare officials initially said they hoped to release the ratings to the public in July. But in a May 12 presentation to hospitals and other interested parties, they did not set a firm date.

Medicare has made minor tweaks in the formula to calculate the stars, but it remains a tough grader, the presentation showed. If Medicare releases its star ratings in July, nearly half of the 3,658 hospitals being evaluated would get three stars, according to Medicare’s preliminary calculations. Only 100 hospitals would receive five stars, while 135 would receive a single star.

The broader debate about the government judging hospitals has been going on since Medicare began publishing quality ratings in 2005, but it has intensified since passage of the Patient Protection and Affordable Care Act, which instructed Medicare to use quality metrics in setting payments.

Teaching hospitals as a group have tended to fare poorly from some of these financial incentives. This year, for instance, nearly half of major teaching hospitals will lose 1% of their Medicare payments because of high rates of infections and surgical complications. Facilities with more low-income patients––who often have a hard time affording medications, following complicated recovery instructions, and getting to doctors regularly––typically have higher readmission rates.

Medicare’s move toward using star ratings is part of an increased focus on easy-to-grasp composite judgments of hospital quality, Kaiser notes. The Leapfrog Group, a nonprofit patient safety group, uses report-card letter grades to characterize hospital safety based on many of the same individual measures used by Medicare. Healthgrades, a Denver-based company, judges hospital quality with one, three, or five stars. Consumer Reports calculates safety scores on a 100-point scale.

Source: Kaiser Health News; May 18, 2016.

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