The CMS' hospital quality star ratings have been strongly criticized by industry stakeholders and Congress as unfairly tarnishing the reputations of hospitals in low-income communities.
A new study reinforces the concerns, concluding that a hospital's rating is heavily influenced by its location's socio-economic conditions.
Hospitals with relatively low star ratings from the CMS were located in cities with high “stress” levels, according to the study, published Monday in JAMA. The stress levels of cities were determined using a 2016 analysis from WalletHub, a finance website that measured socio-economic conditions like unemployment and poverty rates in 150 cities across the country.
The authors averaged the star ratings for all the hospitals located in a particular city. There were 657 hospitals with CMS star ratings located in the 150 cities in the WalletHub analysis.
The ratings assign a composite score of one to five, with five being the highest. Hospitals in Detroit, ranked by WalletHub as the most stressed U.S. city, earned an average rating of 1½ stars from the CMS. Hospitals in Newark, N.J., ranked as the ninth-most stressed, had an average rating of one star.
On the other end of the spectrum, hospitals received an average of five stars in Irvine, Calif., the second-least-stressed city ranked by WalletHub. And in Fremont, Calif., the least-stressed city according to WalletHub, hospitals scored an average of three stars.
According to the CMS, safety net hospitals hospitals on average 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.
David Nerenz, co-author of the study and the director of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit, said he wasn't surprised by the results. “When we look at hospital quality ratings and rankings, what we are seeing has less to do with what the hospitals themselves are doing and more to do with the communities they are located in and the patients they serve,” Nerenz said.
Because the availability of certain services like transportation and social support programs can influence quality metrics like readmission rates, hospital quality star ratings and rankings should account for those factors, Nerenz said. “If we're going to present hospital quality to the public, the goal is to be as precise as possible.”
Industry trade groups have also called on the CMS to re-evaluate its ratings methodology, including how socio-economic conditions influence the results. In a March letter to CMS acting Principal Deputy Administrator Dr. Patrick Conway, the American Hospital Association, the Federation of American Hospitals and other hospital groups called on the agency to be more transparent about how hospitals are ranked.
The CMS delayed publishing the ratings on its Hospital Compare website from April to July after 60 senators and 225 representatives penned letters calling for the CMS to wait.