Hospital groups are criticizing the CMS' plans to publish star ratings of hospitals, claiming the agency calculated those ratings in a way that could inaccurately reflect a hospital's quality. But proponents of greater hospital transparency counter that the CMS should publish the ratings, arguing the benefits far outweigh any limitations.
The American Hospital Association, the Association of American Medical Colleges, America's Essential Hospitals and the Federation of American Hospitals penned a joint letter (PDF) Thursday to Acting Principal Deputy Administrator Dr. Patrick Conway that highlighted “significant underlying methodological problems with its star ratings” and raised concerns that the CMS had not validated its methodology.
“Until the CMS has taken the time to address these problems and share information with hospitals and the public demonstrating that its star ratings methods offer a fair and accurate assessment of hospital quality, we strongly urge the agency to continue to withhold publication of the flawed star ratings,” they wrote.
The ratings in question should convey a hospital's overall quality with a single, composite metric of one to five stars, with five being the best. The CMS originally planned to publish those ratings on its Hospital Compare website in April but delayed doing so after 60 senators and 225 representatives wrote letters urging it to hold off.
In March, the same hospital groups that authored Thursday's letter wrote a letter to the CMS asking the agency to postpone the ratings' publication from April until “at least July 2016,” citing “serious concerns that these star ratings will be misleading to consumers.” The agency later acquiesced, saying it might delay them even beyond July.
The CMS did not provide comment on this story before deadline.
Those who advocate for increased hospital transparency said the star ratings should not be postponed further, adding that the hospital groups' arguments for delaying them did not hold up under scrutiny.
“Any method that you come up with can have criticisms,” said Doris Peter, the director of Consumer Reports' Health Ratings Center. “I think it's a valid approach,” she said of the way star ratings were calculated, adding, “I don't think there's any reason to stop this from getting out to the public.”
One of the factors incorporated into the star ratings is PSI-90, a composite measure of patient safety that includes specific healthcare-associated infections and postoperative complications. Hospital groups contended in their letter that these outcomes should take into consideration socioeconomic factors to compensate for hospitals whose patients are more complex.
But both Peter and Leah Binder, president and CEO of the Leapfrog Group, a not-for-profit that advocates for hospital transparency, separately said that demographics and patient safety should not be so closely linked.
“You really shouldn't make a mistake in surgery, no matter who the patient is,” Binder said.
Having a single rating for a hospital - a complex institution with many departments, providers and services - was by nature imperfect and risks being overly simplistic, Binder added. But these grading systems are easy for consumers to grasp, and as such, publishing ratings would also hold hospitals accountable and push them to improve.
So far, the only star ratings for hospitals published by the CMS date back to April 2015, when the agency introduced them on the Hospital Compare website. Those ratings are tied specifically to patient experience, based on feedback given during doctors and nurses' conversations with patients, hospital cleanliness and other areas.
If the next set of star rankings are published and hospitals score poorly on quality, “they have to explain and defend why they haven't lived up to their reputation,” Binder said. “Hospitals for a very long time have been shielded from that transparent marketplace,” she added. “But those days are over.”