The CMS postponed the release of new overall quality star ratings for U.S. hospitals one day before their scheduled reveal, bowing to pressure from lawmakers and industry stakeholders.
Public release of the data is now slated for July, the CMS said in an e-mail to hospitals Wednesday. Over the next two months, the agency also plans to host calls with providers to clear up questions about current methodology and get feedback on refining the program.
The federal government has been promoting the ratings for hospitals, nursing homes, dialysis facilities and other providers as a way for consumers to compare and select providers. The set that was delayed this week gives hospitals one to five stars based on specific inpatient and outpatient reporting measures.
Hospitals reviewed the ratings earlier this year. Only 87 of more than 3,600 U.S. hospitals got the highest five-star rating, according to the American Hospital Association. Just over half of the hospitals fell within the three-star range. A total of 142 got one star. In January, the AHA challenged the CMS, stating that the program “oversimplifies the complexity of delivering high-quality care.”
That message was heard by 60 U.S. senators who sent a sent a letter to the CMS earlier this month urging the delay of the program. They warned of confusing methods, compromised outcomes for hospitals in disadvantaged communities and the potential to mislead consumers. The AHA and others say they have not been able to come up with the same conclusions as the CMS, using the same data sets and methods.
“The delay is a necessary step as hospitals and health systems work with CMS to improve the ratings for patients,” the AHA said in a statement.
A May 12 call is supposed to educate hospitals on analyzing the data. But, in general, there has been confusion about how best to interpret it.
Different methodologies can produce different results, even when the same raw data sets are used, said Ben Harder and Avery Comarow of U.S. News & World Report in a column posted Thursday.
“No approach to identifying outstanding medical centers is ideal—not ours or the government's or anyone else's,” the column said. Case in point: none of the CMS' five-star facilities made it onto U.S. News' annual Honor Roll, likely because the CMS does not yet adjust for socio-economic factors, Harder said.
That said, not everyone agrees waiting for the perfect measures is the best thing to do. While he acknowledges the challenges to risk-adjusting the measures, William Kramer, executive director of national health policy for the Pacific Business Group on Health, urged the CMS to “move as quickly as possible” with transparency efforts.
“Research has already produced ample evidence that the risk-adjustment for socio-economic status has little impact on the hospitals' performance,” he said in a letter to the CMS. “We do not believe this is justification enough to delay implementation of the hospital star ratings."
While questions remain about the value of the star ratings, a recent JAMA post tied higher scores on the patient-satisfaction rating released last year to better outcomes on mortality and readmission.
The patient-satisfaction star ratings posted on the CMS' Hospital Compare website a year ago were based on an average of hospitals' performance on 11 publicly reported measures from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. That survey includes patient evaluations of the hospital staff responsiveness, care transitions, communication, and cleanliness and comfort of the facility.
The JAMA report, conducted by researchers from Harvard Medical School, found that the higher the patient-satisfaction score, the lower the incidence of patient deaths or readmission for additional care.
