CMS star ratings may penalize hospitals in poor neighborhoods, study finds

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The CMS ratings program that compares hospitals on a scale of one to five stars, may be penalizing hospitals serving disadvantaged communities for factors outside of their control, an analysis published in the journal Medical Care found.

The CMS Hospital Compare program uses various quality metrics and survey data to assign Medicare-certified hospitals a star rating.

University of Chicago Medicine researchers examined associations between neighborhood social risk factors and seven CMS quality scores for 3,608 hospitals across the country. The quality metrics were: effectiveness of care, efficiency of care, hospital readmission, mortality, patient experience, safety of care and timeliness of care.

Researchers found that hospitals caring for vulnerable communities tend to have lower ratings, but they do not have control over social risk factors that disproportionately affect their patients. These social risk factors, which encompass risks in people's lives outside of the hospital, tend to lower scores for timeliness of care, hospital readmissions and patient experience.

Scores for safety, efficiency and effectiveness of care, metrics that measure quality within hospital walls, were not as affected by social risk factors.

"Our study suggests that a hospital's quality rating may be tied to its geographic location — its place," said Elizabeth Tung, MD, senior author of the paper. "Living in a disadvantaged community can influence health directly through social factors like substandard housing conditions, inadequate access to food or transportation and high levels of stress due to safety concerns."

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