CMS overall star ratings 'will do more harm than good to patients,' 2 experts say

CMS released its Overall Hospital Quality Star Rating program in July amidst strong criticism from several stakeholders for a variety of issues. Now, a new Health Affairs blog post says patients will find the ratings "confusing at best and misleading at worst."

The problem, according to authors Susan Xu, a research analyst with the Association of American Medical Colleges, and Atul Grover, MD, PhD, executive vice president at the AAMC, lies in the program's methodology.

CMS uses 64 quality measures in seven categories to calculate its ratings. Three of the categories — mortality, readmission and patient safety — are weighted more heavily than the other four (effectiveness of care, timeliness of care and efficient use of medical imaging). Hospitals have to have a minimum of three measures within at least three of the seven measure groups, including one of the outcomes groups, to receive a rating.

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The problem is that 40 percent of the hospitals that earned a five-star rating from CMS in July did not report enough data on mortality or readmissions.

"The fewer the clinical outcome domains a hospital reports, the less that hospital's overall star rating is actually tied to performance on patient outcomes," the authors wrote.

Additionally, the design of the program seems to put hospitals that reported data for all measure groups at a disadvantage, the Health Affairs article surmised. Of the 30 five-star hospitals that reported data in the minimum of three categories in July, 14 performed higher than the national average in just one category, while just one was above average in all three.

However, hospitals that reported data in all seven categories needed to perform above average in at least three categories to receive a five-star rating.

The ratings also put teaching hospitals at a disadvantage, according to the Health Affairs post, as 80 percent of major teaching hospitals reported on all seven categories, meaning "these hospitals have to meet a higher standard than hospitals with fewer reported quality domains."

The authors concluded, "At a minimum, quality performance among hospitals with the same star rating should be consistent. And higher star ratings should reflect better actual quality performance. Unfortunately, the CMS star ratings in their current form fail to meet this basic test and will do more harm than good to patients."

This isn't the first time the overall star ratings have drawn ire from experts. For instance, Daniel Brotman, MD, a professor of medicine at Baltimore-based Johns Hopkins, called the star ratings "particularly problematic" because they weighed readmissions and mortality equally and readmissions may not be the best way to evaluate hospitals.

Additionally, an economist from Georgetown University in Washington, D.C., found "several shortcomings" in the program's methodology, including that they ignore the hospital's location and patient composition.

More articles on hospital quality:
Detroit Medical Center passes surprise CMS inspection
Hospital quality measures need work: Mass General experts weigh in
Top 47 hospitals where staff always explain medication to patients

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