Hospitals with high patient experience star ratings don't have better outcomes, new analysis finds

CMS started awarding five-star ratings to hospitals based solely on HCAHPS scores in April of last year, and one year later, a research letter published in JAMA Internal Medicine claimed the patient satisfaction-based ratings actually are associated with patient outcomes. However, a recently released study from Quantros produced contrary findings.

According to Quantros's research, that letter's findings are "misleading and may actually steer patients to hospitals with poor clinical outcomes," a statement reads.

Quantros used composite outcomes score including mortality and complication rates as well as patient safety indicators from the Agency for Healthcare Research & Quality for all clinical conditions that carry a high risk of an adverse event — combined, it included more than 300 conditions. Quantros also risk adjusted the hospitals' outcomes for patient characteristics.

It then used its CareChex percentile scoring methodology to distribute the hospitals into percentiles based on that score, and compared those to the hospitals' HCAHPS star rating from CMS.

Instead of mirroring the JAMA Internal Medicine research findings, the Quantros study found one-star hospitals actually outperformed five-star hospitals on the composite score — 6 percent of one-star hospitals had outcome scores in the top 10 percent of the nation, while only 4 percent of five-star hospitals could say the same.

Further, nearly half (47 percent) of all five-star rated hospitals performed below the national average composite score.

Quantros believes its study differed so greatly from the 2015 study in JAMA Internal Medicine from Harvard researchers because of two main differences:

1. The Harvard study used HCAHPS data from the second quarter of 2014 through the first quarter of 2015 and linked it to Medicare patient safety outcomes from 2013, meaning patient experience scores were compared with outcomes from different patient populations.

2. The Harvard study used outcomes data from just three conditions (heart attack, pneumonia and heart failure).

"These findings clearly confirm that consumers cannot safely assume that hospitals with a CMS five-star [HCAHPS] rating will provide better clinical quality than other star-rated hospitals," said Frank Mazza, MD, Quantros's CMO. "In fact, reliance on five-star rating will place them at a substantial risk of choosing a hospital that provides sub-standard care."

This year, CMS released more comprehensive star ratings, which incorporate not only HCAHPS scores but also patient outcomes. "More research will be needed to validate if these ratings provide a reasonable solution for measuring the quality of hospital care in an equitable manner," a Quantros statement reads.

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