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Only 251 Hospitals Score Five Stars in Medicare’s New Ratings

Centers judged on patients' satisfaction

In an effort to make comparing hospitals more like shopping for refrigerators and restaurants, the federal government has awarded its first star ratings to hospitals based on patients’ appraisals, according to a report from Kaiser Health News.

Many of the nation’s leading hospitals received middling ratings, while comparatively obscure local hospitals and others that specialized in lucrative surgeries often received the most stars.

Evaluating hospitals is becoming increasingly important as more insurance plans offer patients limited choices. Medicare already uses stars to rate nursing homes, dialysis centers, and private Medicare Advantage insurance plans. While Medicare publishes more than 100 quality measures about hospitals on its Hospital Compare website, many are hard to decipher, and there is little evidence consumers use the site very much.

Many in the hospital industry fear Medicare’s five-star scale won’t accurately reflect quality and may place too much weight on patient reviews, which are just one measurement of hospital quality, Kaiser says. Medicare also reports the results of hospital care, such as how many died or got infections during their stay, but those are not yet assigned stars.

“There’s a risk of oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons,” the American Hospital Association said in a statement.

Medicare’s new summary star rating, posted April 15 on its Hospital Compare website, is based on 11 facets of patient experience, including how well doctors and nurses communicated, how well patients believed their pain was addressed, and whether they would recommend the hospital to others.

In assigning stars, Medicare compared hospitals with each other, essentially grading on a curve. The Hospital Compare website notes that “a 1-star rating does not mean that you will receive poor care from a hospital” and that “we suggest that you use the star rating along with other quality information when making decisions about choosing a hospital.”

Nationally, Medicare awarded the top rating of five stars to 251 hospitals –– about 7% of the hospitals that Medicare judged, a Kaiser Health News analysis found. Many are small specialty hospitals that focus on lucrative elective operations, such as spine, heart, and knee surgeries. They have traditionally received more positive patient reviews than have general hospitals, where a diversity of sicknesses and chaotic emergency rooms make it more likely patients will have a bad experience.

A few five-star hospitals are part of well-respected systems, such as the Mayo Clinic’s hospitals in Phoenix, Arizona; Jacksonville, Florida, and New Prague, Minnesota. Mayo’s flagship hospital in Rochester, Minnesota, received four stars.

Medicare awarded three stars to some of the nation’s most esteemed hospitals, including Cedars–Sinai Medical Center in Los Angeles, New York–Presbyterian Hospital in Manhattan, and Northwestern Memorial Hospital in Chicago. The government gave its lowest rating of one star to 101 hospitals, or 3% of the facilities that were evaluated.

On average, hospitals scored highest in Maine, Nebraska, South Dakota, Wisconsin, and Minnesota, Kaiser found. Thirty-four states had no one-star hospitals.

Hospitals in Maryland, Nevada, New York, New Jersey, Florida, California, and the District of Columbia scored lowest on average. Thirteen states and the District of Columbia did not have any five-star hospitals.

In total, Medicare assigned star ratings to 3,553 hospitals based on the experiences of patients who were admitted between July 2013 and June 2014. Medicare gave four stars to 1,205 hospitals, or 34% of those it evaluated. Another 1,414 hospitals (40%) received three stars, and 582 hospitals (16%) received two stars. Medicare did not assign stars to 1,102 hospitals, primarily because not enough patients completed surveys during that period.

While the stars are new, the results of the patient satisfaction surveys are not. They are presented on the Hospital Compare website as percentages, such as the percentage of patients who said their room was always quiet at night. Often, hospitals can differ by just a percentage point or two, and until now Medicare did not indicate what differences it considered significant. The Centers for Medicare & Medicaid Services (CMS) also uses patient reviews in doling out bonuses or penalties to hospitals based on their quality each year.

Some groups that do their own evaluations of hospital quality questioned whether the new star ratings would help consumers. Jean Chenoweth, an executive at Truven Health Analytics, which publishes a list of top hospitals, said she feared hospital marketing departments would oversell the meaning of the stars. “It would be very unfortunate and misleading if a hospital marketing department could claim to be a CMS five-star hospital and fail to mention it only reflected a patients’ perception of care,” she said.

Sources: Kaiser Health News; April 16, 2015; and HCAHPS Star Ratings; 2015.

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