CMS has identified ways that hospitals can—and cannot—improve their overall star ratings.

July 27—As expected, the Centers for Medicare & Medicaid Services (CMS) on Wednesday launched the previously delayed overall hospital quality star-rating system.

Andy Slavitt, acting administrator for CMS, said in a tweet the ratings were released after “working closely” with hospital groups. However, hospital organizations two days earlier backed legislation that would require CMS to pull the ratings down. And hospital groups said they would continue working to have the ratings pulled down until their concerns about the methodology used to create the star system are addressed.

Regardless of whether the star system is eventually revised or removed, hospitals should know how the new rating system works.

Here are 18 key aspects of the new ratings system.

  1. The new rating summarizes data from existing quality measures that are publicly reported on the Hospital Compare website into a single star rating for each hospital.
  2. The new rating will include 64 of the more than 100 measures displayed on Hospital Compare.
  3. Hospitals are assessed only on the measures for which they submit data. Some hospitals may report as few as nine measures.
  4. Specialized and cutting-edge care that certain hospitals provide, such as specialized cancer care, are not reflected in these quality ratings.
  5. A complete list of measures included in the overall star rating is available on QualityNet.
  6. The overall star ratings will not replace measures currently displayed on Hospital Compare.
  7. The 64 measures are categorized into seven mutually exclusive groups: Outcomes—mortality; Outcomes—safety of care; Outcomes—readmissions; Patient experience; Process—effectiveness of care; Process—timeliness of care; and Efficiency—outpatient imaging use.
  8. The PSI-90 (a composite measure consisting of eight weighted patient-safety-indicator measures) and the hospital-wide readmission measures will be included in the overall hospital star rating despite recent concerns expressed by some providers.
  9. Claims-based measures, including mortality, readmission, and PSI-90, are calculated using only Medicare fee-for-service hospital claims data. Process-of-care, healthcare-associated infection, and HCAHPS survey measures include data from all payers.
  10. There is a nine-month time lag for the HCAHPS survey data used in the ratings.
  11. Hospitals can improve their star ratings by improving quality across all reported measures—particularly outcome measures and patient experience measures, which receive higher weighting.
  12. Overall star ratings are based on relative performance. Hospitals that improve more than other hospitals are likely to achieve higher ratings.
  13. Hospitals cannot improve their ratings by selecting the measures for CMS to report. Ratings are based on reported measures across seven categories that meet the inclusion criteria.
  14. The star rating will be updated quarterly and will incorporate new measures as they are publicly reported on the website as well as remove measures that are retired from the quality-reporting programs. A specific schedule for updates has not been determined.
  15. Hospitals cannot affect their rating before the following quarterly update, so submitting new data more quickly will not accelerate the star updates.
  16. Hospitals can correct suspected errors or appeal their star rating by submitting a request along with their CMS certification number through the inpatient and outpatient question-and-answer tools.
  17. CMS will continue to analyze the star-rating data and consider public feedback to make enhancements to the scoring methodology as needed, according to a release.
  18. CMS will not use the overall hospital star ratings to change payments for those facilities.

“We will continue to work closely with hospitals and other stakeholders to enhance the Overall Hospital Quality Star Rating based on feedback and experience,” Kate Goodrich, MD, director of the Center for Clinical Standards and Quality at CMS, wrote in a blog post.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C. office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Wednesday, July 27, 2016