Communicating a low star rating: A playbook for 1-star hospitals

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CMS released its Overall Hospital Quality Star Ratings at the end of July — despite strong criticism of their accuracy and fairness — and the ratings revealed 129 hospitals received the lowest possible rating: one star.

While many hospitals and other stakeholders have formally complained about the methods behind the ratings' metrics, the ratings are more than likely here to stay, says Rita Numerof, PhD, president and co-founder of Numerof and Associates, a healthcare management consulting firm.

"People need to understand that these ratings are an important change in a business model that reflects a much-needed focus on greater transparency, accountability and an attempt to connect payment to outcomes," she tells Becker's. "We should all applaud that effort, whether or not the specific star ratings or results are what the organization likes."

Organizations with lower than expected scores should not only focus on improving outcomes, but they also need to manage their communication about the ratings, both internally to staff members and clinicians as well as externally to local media and patients, to stem potential negative reactions.

Dr. Numerof broke down a strategy for both in a recent conversation with Becker's.

Internal communication

Employees and clinicians want to work and practice at a top-notch hospital, so learning their hospital essentially earned a failing grade compared to peers can come as a "punch in the chest," says Dr. Numerof. "No one wants a poor rating, and people are working hard to do their best, not intentionally creating harm," Dr. Numerof says. "It's really devastating for people within the organization."

That's why it's important for members of the C-suite to acknowledge the emotional toll a one-star rating can have on the team and on themselves. For example, Jim Nathan, president and CEO of Lee Memorial Health System in Fort Myers, Fla., publicly shared his feelings about receiving the lowest possible rating from CMS, telling the News-Press he was "emotionally devastated" when he learned all four of his system's hospitals earned one star.

After the emotional fallout is recognized, it is imperative for leaders to look into the data behind the low score to figure out where the hospital fell short. "Regardless of whether we agree with the [ratings] or not, we need to acknowledge that they are a data point and understand how that data came to be," Dr. Numerof says. That way, hospitals understand where the score came from and what, if anything, needs to change.

In this regard, a one-star rating can be viewed in a positive light. "It can be a really important rallying cry for the entire organization to get more serious and more focused around what they need to do differently," Dr. Numerof says, adding that doing so can serve as a jumping off point to focus on getting to zero defects.

External communication

Some hospitals may struggle with how to respond to local media when confronted with a failing grade. Dr. Numerof says it is critical to be proactive about media outreach and acknowledging the ratings. "The first message [should be] an acknowledgement of how important safety and quality are to the organization," Dr. Numerof says. Hospitals should make it clear they are not "blowing it off" and are committed to making changes to improve the rating.

For instance, Lee Memorial CEO Mr. Nathan told local media the system is "fully committing to our goals of performing consistently at a five-star level" and that it formed a rapid response quality team to address problem areas.

That being said, Dr. Numerof says hospital officials shouldn't shy away from mentioning concerns with the ratings' methodology. "Being able to acknowledge that there are questions or concerns about how some of the measures are put together is perfectly legitimate," she says. For instance, executives could show that CMS used older data to calculate its ratings and then show any more recent data they have on certain points.

That is a tactic Lee Memorial used as well, showing local media how certain infection rates have fallen in the last two years that may not have been reflected in the data CMS used.

The future

Regardless of a hospital's current rating, be it one or five stars, administrators and clinicians need to stay on their toes, as CMS plans to update its overall star ratings each quarter.

"It is a moving target — any outcome measure is going to be dependent of an ongoing performance of an organization," Dr. Numerof cautions.

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