CMS star ratings disproportionately benefit specialty hospitals, data show
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • FCC Chairman Pai on funding telehealth, 5G and the digital divide
      Hospital M&A activity rebounds in Q4
      Surgeon General calls on businesses to invest in community health
      Providers await new HHS coronavirus grant reporting deadline
    • Hospital M&A activity rebounds in Q4
      Surgeon General calls on businesses to invest in community health
      Providers await new HHS coronavirus grant reporting deadline
      Louisiana gets reports vaccine providers are discriminating
    • Louisiana gets reports vaccine providers are discriminating
      'We know this is real': New clinics aid virus 'long-haulers'
      The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
      Trenda Ray
      Q&A: Arkansas nursing leader looking for creative staffing solutions as COVID cases surge
    • CMS approves rule forcing insurers to ease prior authorization
      COVID-19 still a big uncertainty for insurers in 2021
      Health insurers' outlook boosted after Dems' Georgia win
      humana_i.jpg
      Humana supports Ohio not-for-profits with $500,000
    • FCC Chairman Pai on funding telehealth, 5G and the digital divide
      Quest Diagnostics wins CDC contract to sequence coronavirus samples
      Biden picks transgender woman as assistant health secretary
      The Check Up: Chip Kahn
      The Check Up: Chip Kahn of the Federation of American Hospitals
    • Providers await new HHS coronavirus grant reporting deadline
      Operation Warp Speed Dr. Moncef Slaoui, Pfizer Group President Angela Hwang, Moderna CEO Stephane Bancel, CVS Health Executive Vice President Karen Lynch and McKesson CEO Brian Tyler participate in a panel discussion on the COVID-19 vaccine.
      Hospitals, drug companies strive to stand out virtually at JPM
      Intermountain, Trinity, Memorial Hermann behind $300M private equity fund
      Operation Warp Speed to bump up McKesson's stock price
    • A man in a room with servers.
      Momentum grows to outsource hospital tech functions in 2021
      5 things to know about Google's $2.1B Fitbit acquisition
      Providence bets on machine-learning, consolidating data centers
      Mental health treatment was most common telehealth service during COVID
    • Sticking to Mediterranean diet is good for the brain
      Chance of COVID-19 triage care looms over Arizona hospitals
      U.S. ramps up vaccinations to get doses to more Americans
      367146427.jpg
      Should businesses mandate that staff get the COVID vaccine?
    • Providence names new chief financial officer
      Wisconsin's top health official departing for federal job
      Cone Health CEO, CFO to depart amid pending Sentara merger
      Tower Health's finance chief resigning after years of steep losses
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • InDepth Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
      Yale New Haven's COVID-19 nurse-staffing model has long-term benefits
    • Dr. James Hildreth
      How medical education can help fight racism
      Modern Healthcare InDepth: Breaking the bias that impedes better healthcare
      Videos: Healthcare industry executives describe their encounters with racism
      Michellene Davis
      Healthcare leadership lacks the racial diversity needed to reduce health disparities
      Hospital divided into multiple pieces
      Health systems may be warming to offshoring, a mainstay practice for insurers
    • A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      self service station
      COVID-19 pushes patient expectations toward self-service
      Targeting high-risk cancer patients with genetics
      A nurse holds up a phone with a message to a family member saying surgery has started.
      Texting, tablets help hospitals keep family updated on patient care
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Highmark Health inks six-year cloud, tech deal with Google
      Study: 1 in 5 patients report discrimination when getting healthcare
      HHS proposes changing HIPAA privacy rules
      Android health records app launches at 230 health systems
    • California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
      Healthcare was the hardest hit by supply shortages across all U.S. industries
    • A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      New care model helps primary-care practices treat obesity
      How hospitals are building on COVID-19 telehealth momentum
      Researchers: Hospital price variation exacerbates health inequities
    • MedPAC votes to boost hospital payments, freeze or cut other providers
      Most Next Gen ACOs achieved bonuses in 2019
      Congress recalibrates Medicare Physician Fee Schedule after lobbying
      CMS approves rule to encourage value-based drug pricing
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
      Dr. Bruce Siegel
      Why taking a hospital not-for-profit was Dr. Bruce Siegel’s boldest move
    • Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
      Mark C. Clement and David Cook
      We all need to 'do something' to fight inequities and get healthcare right, for every patient, every time
    • Dr. Bruce Siegel
      By protecting the healthcare safety net, Biden can put us on the path to a stronger country
      Healing healthcare: some ideas for triage by the new Congress, administration
      Dr. Sachin H. Jain
      Medicare for All? The better route to universal coverage would be Medicare Advantage for All
      Connectivity: a social determinant of health that can exacerbate all the others
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Open - Health Care Hall of Fame
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Top 25 Minority Leaders
    • Top 25 Women Leaders
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • Leadership Symposium
    • Healthcare Transformation Summit
    • Women Leaders in Healthcare Conference
    • Workplace of the Future Conference
    • Strategic Marketing Conference
    • Social Determinants of Health Symposium
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala (2022)
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
      Next Up Podcast: COVID-19, social determinants highlight health inequities — what next?
      Ceci Connolly
      Next Up Podcast: How to navigate the murky post-election waters
      Next Up Podcast: Saving Rural Health
    • An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
      doctor burnout
      Beyond the Byline: How healthcare supply chain struggles contribute to employee burnout
      Beyond the Byline: Covering race and diversity in the healthcare industry
      Beyond the Byline: How telehealth utilization has impacted investor-owned company earnings
    • Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Chip Kahn
      The Check Up: Chip Kahn of the Federation of American Hospitals
      The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
      The Check Up: Dr. Kenneth Davis
      The Check Up: Dr. Kenneth Davis of Mount Sinai Health System
      The Check Up: Dr. Thomas McGinn
      The Check Up: Dr. Thomas McGinn of CommonSpirit Health
    • Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Providers
March 14, 2018 01:00 AM

CMS star ratings disproportionately benefit specialty hospitals, data show

Maria Castellucci
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print

    The CMS' latest star-ratings formula disproportionately rates specialty hospitals better than major teaching hospitals, according to a Modern Healthcare analysis of quality performance data.

    The CMS updated its star ratings in December with a new formula intended to improve accuracy and fairness. But a study of the most recent CMS data by consulting firm Sullivan, Cotter and Associates and Modern Healthcare show that the majority of specialty hospitals received five-star ratings—the highest rating a facility can receive—while a small number of major teaching hospitals received the same recognition. Of the 74 specialty hospitals that received a star rating in December, 45—or 61%—received a five-star rating and 16—or 22%—received a four-star rating, according to the Sullivan Cotter analysis. By comparison, of the 172 major teaching hospitals that received a star rating from the CMS, just 15—or 9%—got a five-star rating and 25—or 15%—received four stars. The analysis also found that specialty hospitals only reported about half of the measures the CMS considers to assign ratings and the measures reported were weighted higher under the methodology. Experts say the findings highlight consistent issues with the CMS' star-ratings methodology. "There is a clear bias here towards the critical-access hospitals and the specialty hospitals and much of it is driven by the methodology in terms of how the measures are aggregated into a single rating," said Andrew Wilson, research team leader at Altarum's Center for Value in Health Care, of the results. Hospitals care deeply about the star ratings even though it's unknown how often they are used by consumers. There haven't been any studies on how many Medicare beneficiaries use the Hospital Compare site, where the star ratings are featured, and the CMS said it's unable to determine accurately how many Hospital Compare visitors are beneficiaries. The American Hospital Association, the Federation of American Hospitals and America's Essential Hospitals all campaigned strongly against publishing the star ratings in 2016. The main concern for the organizations was the methodology, which it characterized as "flawed," saying that it "unfairly" penalizes teaching hospitals or those who serve large poor populations. Even though hospitals opposed publishing the star ratings, high performers tout their success in news releases and news stories and say the recognition is an indicator of quality care. The methodology Under the CMS' latest star-ratings formula, the agency removed winsorization, a tactic in which extreme hospital outliers in the data set were trimmed to minimize their effect on the overall ratings. Instead, the CMS runs k-means clustering "to complete convergence." This involves clustering hospitals repeatedly into five groups—or star categories—until the hospitals in each group are more similar to each other and different enough from the other four groups. The new formula addresses concerns that hospitals in different star categories performed similarly on the measures. The change slightly flattened the usual bell curve of hospitals that receive stars on a scale of 1 to 5, with 5 being the highest rating. In the previous methodology, few hospitals received one or five stars, and the majority have two, three or four stars. While that's still the case, the number of hospitals with one or five stars rose. Although the CMS changed that part of its methodology, the quality measures used and the weight applied to those measures weren't altered. All in all, hospitals can report up to 57 measures to obtain a star rating. These are divided and weighted into seven categories: mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care and efficient use of medical imaging. The three outcome groups—readmissions, safety and mortality—are each weighted the most at 22% each. Patient experience is also weighted at 22%. Effectiveness of care, timeliness of care and efficient use of medical imaging are each weighted at 4%. To qualify for a star rating, hospital must report measures for at least three of the categories, one of which must be an outcome category like readmission or mortality. If a hospital doesn't report all of the measures, the CMS will weigh the submitted data more heavily. In December a total of 3,692 hospitals received a star rating. Critics of the star ratings, including the AHA, argue that how the measures are weighted skews the results so hospitals can appear to be better or worse performers than they actually are. "When you are looking at the star ratings, you really aren't getting as clear of a picture on the performance of the hospitals as you would want to," said Nancy Foster, vice president for quality and patient safety policy at the AHA. "You are getting this blend of measures that aren't adequately adjusted … you end up with this strange distortion." The CMS disagrees with critics, arguing that its star-ratings methodology "is not designed to advantage or disadvantage any type of hospital," a spokesman said in an email. He added, "Our analyses show that hospitals' star ratings are strongly correlated with the hospital performance on the individual quality measures." But the CMS data suggest that the specialty hospitals benefited from higher ratings by reporting fewer measures—particularly fewer outcome measures—than teaching hospitals. Differences in reporting Specialty hospitals that received a rating reported 27.2 of the 57 measures on average, according to Sullivan Cotter's analysis. Comparatively, major teaching hospitals that received a rating reported almost all of the measures, 51.37 of the 57 measures on average. The specialty hospitals were less likely to have the heavily weighted mortality measure considered in their star rating compared to the major teaching hospitals. Data showed the CMS didn't consider mortality for 71% of the five-star specialty hospitals. Jeff Softcheck, principal at Sullivan Cotter, emphasized that the specialty hospitals don't report all the measures because their patients don't present with those conditions. For instance, most specialty hospitals don't provide care to patients with congestive heart failure or stroke. By comparison, the 172 major teaching hospitals reported all of the measures needed to fulfill the patient experience, readmissions, mortality and safety categories. Because of how the methodology is set up, hospitals that perform below average on any of the four heavily weighted measures have to perform above average on the other three measures in order to get four stars or higher, Softcheck said. That can be hard for the major teaching hospitals because they are being compared to hospitals with much different patient populations, said Dr. Mark Rumans, chief medical officer at Sullivan Cotter. Major teaching hospitals, which typically treat complex conditions for patients with various socio-economic factors, have to compete against specialty hospitals that often work with insured patients on elective procedures. "If you end up at a major teaching hospital you are really sick … you are seeing multiple specialists, your length of stay is long," Rumans said. "Compare that to the experience at a specialty hospital, which has lengths of stay of one or two days. Those are such different levels of experience." The data show that 52.5% of the 40 four- and five-star major teaching hospitals performed below average on readmissions. Most made up for their score by performing above average in the mortality, patient experience and safety categories. Suggested changes Critics say a major problem with the star ratings is that it combines all hospitals together in the dataset and compares them all to each other. The AHA supports better risk adjustment so hospitals with similar patient mix or services are compared to each other. Others argue that the star ratings should display a hospital's performance on measures by specific condition so it's more helpful to patients. Right now, the star ratings can't tell a patient if the hospital is a good choice for a knee replacement because it combines all "these measures that aren't correlated with each other—that is the fundamental problem," said David Nerenz, the director of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit. Nerenz suggests that individual measures for individual procedures are displayed so consumers can decide what information is important to them. David Levine, senior vice president of advanced analytics and informatics at Vizient, also criticized the timeliness of the CMS data, which is mostly from 2016. "CMS is getting claims data all the time, they should be able to (update the data) on a more frequent basis," he said. The CMS said that it will continue to look for more opportunities to improve the star ratings and gather input from stakeholders. The AHA's Foster confirmed that the organization continues to talk to the CMS about ways to improve the star ratings. The CMS is expected to release updated star ratings in July. Editor's Note: Sullivan Cotter used its own methodology to categorize hospitals by five types: specialty, critical-access, small or medium community, large community or minor teaching and major teaching. The firm considers numerous sources to establish the groups including the American Hospital Association Guide. An edited version of this story can also be found in Modern Healthcare's March 19 print edition.
    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Louisiana gets reports vaccine providers are discriminating
    Louisiana gets reports vaccine providers are discriminating
    'We know this is real': New clinics aid virus 'long-haulers'
    'We know this is real': New clinics aid virus 'long-haulers'
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • InDepth Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Top 25 Minority Leaders
        • Top 25 Women Leaders
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Leadership Symposium
        • Healthcare Transformation Summit
        • Women Leaders in Healthcare Conference
        • Workplace of the Future Conference
        • Strategic Marketing Conference
        • Social Determinants of Health Symposium
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala (2022)
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing