Hospital Star Ratings: 5-Star Hospitals are Few and Far Between

As of April 16, consumers can go to the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website and select up to three hospitals to get their star rating and other comparative data to help them select a hospital for non-emergency surgeries or other procedures. Of the 3,553 hospitals reporting data, 561 (approximately 7 percent) received a 5-star rating. The star ratings are currently based on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data gathered through a standardized survey tool administered to random patients throughout the year. Hospitals must have at least 100 completed surveys in a 12-month period to receive a star rating. CMS, working with Yale University, plans to incorporate all of the data reported through Hospital Compare to make up the star rating as soon as 2016. Hospital Compare is part of CMS’s hospital quality initiative designed to improve quality in hospitals by providing a set of objective, easy-to-understand information on hospital quality from a consumer’s perspective. Ideally, as hospitals strive to improve their star rating, their quality will improve also. The data is to be updated quarterly by CMS. As part of moving the Medicare program to a value-based payment system, the outcomes of patient surveys can affect a hospital’s bottom line. At some point, compliance problems may arise in cases where hospitals manipulate data to appear more favorable or an ancillary service, like a laboratory, goes too far in supporting a hospital or physician’s quality reporting, resulting in increased reimbursement for the hospital or physician.
Part of CMS’s Overall Transparency Effort According to a CMS press release, these are the first ever star ratings for hospitals but not for some of the other categories of public reporting designed to enhance quality and aid consumer choice. The new ratings are part of a U.S. Department of Health and Human Services larger effort to build a health care system that delivers better quality of care, uses health care dollars wisely and results in healthier people. “These star ratings also encourage hospitals and clinicians to strive to continuously improve the patient experience and quality of care delivered to all patients,” said Patrick Conway, Acting Principal Deputy Administrator for CMS and Deputy Administrator for Innovation and Quality in the press release announcing the new ratings. The data compares information about the patient experience, as reported in the HCAHPS consumer satisfaction surveys in 11 patient satisfaction categories. Star ratings and comparative data are not confined to hospitals. There are also comparative data and/or star ratings on nursing homes, large physician practices, dialysis facilities, Medicare Advantage health plans and home health. The hospital rating website allows the user to view data for a single hospital or compare information on up to three hospitals in the patient’s service area selected by zip code or state. The website provides general information for the hospital such as the address, type of hospital, whether it provides emergency services and, surprisingly, whether or not it is able to receive and track laboratory results through the use of a certified electronic health record system. It also asks if the hospital uses a safe surgery checklist. A review of the data being reported reveals that laboratory services play an important role in monitoring quality of hospitals. For instance, in the section on health care associated infections, there are two laboratory-identified events: Methicillin-resistant Staphylococcus Aureus infections and Clostridium difficile (C. diff.) infections. The 11 measures of patient satisfaction include:

• How well did doctors and nurses communicate with the patient;
• How long did it take to get help after asking for it;
• How well pain was controlled;
• Cleanliness of the hospital room and the facility overall;
• Whether or not the patient received discharge instructions and if he or she understood them; and
• The percentage of patients rating the hospital as a 9 or 10 on a scale of 0 to 10 and whether they’d recommend the hospital to others.

Users can review aggregate comparisons such as averages in the country and can select the format displaying the data, such as a chart or graphical representation.
Hospitals and Others Point Out Flaws Not everyone is a fan of the consumer-based star rating system of comparing hospital quality and service data. The American Hospital Association (AHA), through its publication Hospital and Health Networks Daily, warns that the use of a single overall rating has some risks, quoting Akin Demehin, AHA senior associate director of policy: “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 risks and benefits of transparency in health care areas like quality, prices, outcomes and other categories are being closely studied by many. Some fear that a consumer-focused star rating system places too much weight on the patient’s perspective rather than other statistically valid information. Others argue that star ratings are something consumers are familiar with and place value in, while other rating systems are too complex and difficult for patients to understand. Hospital compare is another tool made available to consumers to help make better decisions about the care they receive and who provides that care. This information becomes more important than ever as patients are being asked to pay for more of their care out of their own pocket and take more control over their own health. Adding the star ratings summary data makes it easier for consumers to use information about hospital quality of care and the service a patient can expect; it has the added advantage that it is a common method of rating products and services. Takeaway: Laboratories and the data they own could have a significant role in quality measurement, affecting payments positively or negatively.