Hospitals ponder meaning, value of CMS' new star ratings

About 7% of hospitals got the highest rating, 34% got the second-highest rating, and 19% got one of the two lowest possible scores in the CMS' new five-star ratings of more than 3,500 hospitals based on patient-satisfaction surveys.

The star ratings, posted on the CMS' Hospital Compare website April 16, are based on an average of hospitals' performance on 11 publicly reported measures from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. The HCAHPS survey includes patient evaluations of the hospital staff responsiveness, care transitions, how well information about medications is communicated, and cleanliness and quietness of the facility. The inaugural ratings came from patient responses gathered between July 1, 2013, and June 30, 2014.

The American Hospital Association questioned the value of the star ratings. “The reasons that patients seek care from hospitals are varied,” said Akin Demehin, the AHA's senior associate director of policy. “We are not confident that a star-rating approach—especially one that would encompass all of the measures on Hospital Compare and roll them up into a single overall star rating—is going to give patients the insight on the quality of their hospitals that CMS is hoping for.”

One of Minneapolis-based Allina Health's 12 hospitals received the highest rating of five stars, nine Allina hospitals got four stars and two got three stars. But the system's CEO, Dr. Penny Wheeler, was cautious about celebrating her system's high scores because of her concerns about the data. “It's not perfect, no measurement system is,” she said. But “flawed data is still better than no data,” she added.

Johns Hopkins Hospital in Baltimore received four stars, which Lisa Allen, the hospital's chief patient experience officer, attributed to its long-standing best practices. Still, she questioned the rating methodology's value for consumers, who must consider the type and complexity of care they need. She urged the CMS to consider posting patient comments, the way other ratings sites do for restaurants and hotels. She said consumers evaluating service providers “tend to also read the reviews. We don't just look at the stars.”

Some hospitals that received low star ratings said that if the CMS had used more current information, they would have earned better scores, reflecting their efforts to improve quality of care and the patient experience. Some organizations also acknowledged they had only recently launched systemwide quality and patient satisfaction improvement efforts.

“We were late to the dance on this,” said Airica Steed, chief experience officer at the University of Illinois Hospital & Health Sciences System in Chicago, which was one of 582 hospitals receiving two stars from the CMS. Steed, who was hired in 2012, said she was not surprised by her hospital's score because it takes time for new processes to be disseminated and lead to better outcomes. “But I would be surprised if, fast forward, we get the same rating in the next rendition,” she said. “The rating truly reflects the gap of what our baseline was at the starting point.”

Jackson Memorial Hospital in Miami, a major safety net facility, was one of 101 hospitals receiving one star. Kevin Andrews, Jackson's vice president of quality and safety, attributed the low rating to financial challenges the public hospital has experienced over the past few years. “You're in survival mode when you're having financial issues,” he said. “That's not an excuse to not provide good service, but it's the reality.”

Many specialty hospitals did well in the CMS star ratings. Modern Healthcare identified more than 60 specialty facilities among the 250 that received five stars. Experts say it may be easier for facilities specializing in elective orthopedic, cardiac and other service lines to achieve strong patient satisfaction scores because of their smaller size, narrow clinical focus and the fact that their patients generally don't arrive via the emergency department.

In a written statement, Dr. Patrick Conway, the CMS' acting principal deputy administrator, said his agency's star ratings encourage hospitals and clinicians to strive to continuously improve the patient experience and quality of care delivered to all patients. The CMS already uses star ratings for nursing homes, dialysis centers and Medicare Advantage plans.

Allen of Johns Hopkins said it remains to be seen if consumers will actually use the star ratings to make choices about where to get their care. At the least, the star ratings should increase providers' focus on the patient experience and their HCAHPS survey results. “Everybody is paying attention to this now,” she said. “And that's a good thing.”