(Story updated at 3:15 p.m. ET)
The CMS published the much-anticipated verall hospital quality star ratings on Wednesday after industry stakeholders and Congress pressured the agency to continue to delay their release.
The ratings are a composite metric of one to five stars, with five being the best. They intend to convey the overall quality of nearly 4,000 hospitals in the U.S and are posted to the CMS' Hospital Compare site. In grading hospitals on their overall quality, the CMS used 64 measures, such hospital-acquired infection rates or emergency room wait times, that had already been posted to the Hospital Compare site. It grouped those measures into broader categories, then weighted them. Hospitals had to meet minimum reporting requirements in order to be eligible to receive a star rating.
"These easy-to-understand star ratings are available online and empower people to compare and choose across various types of facilities from nursing homes to home health agencies," Dr. Kate Goodrich, director of the Center for Clinical Standards and Quality at CMS, wrote in a blog post announcing the star ratings' release.
Hospitals and other industry groups have stridently criticized the rating system as oversimplifying a complex matter—the quality of a multi-faceted institution—and the underlying methodology as flawed. They warned it would provide inaccurate information to consumers and damage hospitals' reputations.
The American Hospital Association said it was "disappointed" the CMS decided to release the ratings. "As written, they fall short of meeting principles that the AHA has embraced for quality report cards and rating systems," its president, Richard Pollack, said in a statement Wednesday. "We are especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor."
On average, safety net hospitals hospitals earned slightly lower ratings, with a mean of 2.88 stars, than did non-safety net hospitals, which garnered an average rating of 3.09 stars, according to distribution data released Thursday by CMS.
Just 102 institutions out of 4,599 hospitals, or 2.2%, earned five stars. Of the rest of the hospitals, 20.3% garnered four stars, 38.5% received three, 15.7% earned two stars and 2.9% received a single star. A significant proportion—20.4% of hospitals—were deemed ineligible for ratings, because they lacked data to report measure results.
"This does not necessarily mean that a hospital did not report any data, or that a hospital provides poor quality care," Aaron Albright, CMS's director of media relations, said in an email. "The facility could be new or small, or have an insufficient number of cases reported."
The CMS originally planned to release the star ratings in April, but backed off after 60 senators and 225 representatives penned letters calling for CMS to wait.
“We have heard from hospitals in our districts that they do not have the necessary data to replicate or evaluate CMS's work to ensure that the methodology is accurate or fair,” the letter from the representatives said.
The CMS then said it would wait until July to release the star ratings, and it has moved forward despite a final push by those who oppose the star ratings in their current form.
Two U.S. representatives introduced a bill Monday to delay the release of the star ratings another year.
“I still have real concerns that this system could unfairly penalize teaching hospitals and hospitals that serve poor communities, and that patients will ultimately pay the price," said Rep. Kathleen Rice (D-NY), who co-sponsored the bill introduced Monday. She added that she was still working on the bill, which also contained a provision to rescind the ratings in the event they were published.
Rep. Jim Renacci (R-Ohio) also said he was disappointed by the release of the star ratings and reiterated concerns that they did not adequately reflect hospital performance.
Early in the month, hospital groups including the AHA, the Association of American Medical Colleges, America's Essential Hospitals and the Federation of American Hospitals wrote a letter to CMS' Acting Principal Deputy Administrator Dr. Patrick Conway, urging the agency to delay again.
"We urge CMS to share additional information with hospitals and the public about how accurately star ratings portray hospital performance," the letter said.
Goodrich stated in the blog post that the agency had conducted outreach to hospitals in an effort to assuage concerns.
"We continue to work closely with the National Quality Forum and the Assistant Secretary for Planning and Evaluation (ASPE), who is required by the IMPACT Act to study the effect of socioeconomic status on quality measures and payment programs based on measures," Goodrich wrote. She said CMS is open to adjusting the measures based on recommendations by the ASPE.
CMS currently uses star rating systems as quality indicators for nursing homes, Medicare plans and dialysis facilities. Some of those, too, were not without controversy. When CMS published the metric for nursing homes in 2009, industry groups pushed back. Later, an investigation of the system by the New York Times found that many of the metrics that went into nursing home ratings were incomplete and sometimes misleading.