The Medicare Payment Advisory Commission has added its influential voice to those questioning the accuracy of the CMS' hospital quality star-rating system and whether or not it penalizes hospitals with the sickest patients. The panel, which advises Congress on Medicare spending, will develop its own quality measures and a corresponding payment structure.
The CMS released the ratings this summer despite pressure from Congress and industry stakeholders to delay or tweak the system. They and others say the system oversimplifies a complex matter and could hurt hospitals' reputations.
The ratings are a composite metric of one to five stars, with five being the best. The CMS uses 64 measures to gauge the overall quality of nearly 4,000 hospitals in the U.S. and the ratings are posted to the CMS' Hospital Compare site. The goal is to help inform consumers' choices on hospitals.
MedPAC analyzed the rating system and found that of the 102 five-star hospitals only 57 were rated on all outcome measures, which include mortality, readmissions, safety and patient experience.
But nearly all of the 129 hospitals with a one-star rating were rated on all the outcome measures. On average, safety net 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.
“The commission is concerned that the current hospital star-rating program may not fully account for the differences in the intrinsic health risks that patients bring to the hospitals and therefore may not produce true 'apples-to-apples' comparison of hospitals,” MedPAC said in a letter (PDF) sent to acting CMS Administrator Andy Slavitt.
For example, a one-star hospital on average had 78% of admissions through the emergency room, versus 36% at five-star hospitals.
“One-star hospitals are treating a greater share of likely more severe cases” from the ER, MedPAC said. “This suggests that there may be a need for improved adjustment with respect to the complexity and satisfaction of patients receiving emergency care.”
Hospital insiders have also raised concerns that the star-rating system needs to be adjusted for those that tend to serve sicker patients, according to Dr. David Levine, medical director and vice president for advanced analytics/informatics at Vizient, a healthcare performance improvement company based in Texas.
A CMS spokeswoman confirmed that it received the letter and that the agency is drafting a response.