Hospital star-ratings release delayed by CMS

The CMS will not update the hospital quality star ratings on Hospital Compare next month as it continues to evaluate concerns from stakeholders on methodology changes, the agency told hospitals on Tuesday.

The agency had posted proposed changes to the methodology in late May for hospitals to preview before the July release. Now, the CMS said it needed additional time to analyze "the impact of changes to some of the measures on the star ratings and to address stakeholder concerns."

The ratings from December 2017 will remain on the site, the CMS said.

The CMS had delayed the star ratings release last July as well in response to concerns from stakeholders. Typically, the ratings are released in July and December.

No date was set for when the next round of star ratings will be released. The CMS said it will gather feedback from a multidisciplinary expert panel and a work group of provider leaders. A public comment period will also be set.

The proposed methodology increased the number of 1-star hospitals from 260 hospitals in December to 338 hospitals in July. At the same time, the number of 5-star hospitals slightly rose from 337 in December to 375 in July.

Provider advocates said they support the delay. Dr. Bruce Siegel, president and CEO of America's Essential Hospitals, said the "large shifts" hospitals saw in their ratings "has created confusion and raised new questions about the reliability and validity of the methodology used to calculate these ratings."

Safety-net hospitals, which America's Essential Hospitals represent, are less likely to get 5-star marks than their specialty and critical-access hospital peers, a Modern Healthcare and Sullivan, Cotter and Associates analysis earlier this year found.

The American Hospital Association, which has historically criticized the star ratings, also supports the CMS' decision to delay the July ratings. "CMS made the right call in postponing the July update of star ratings, and we appreciate the agency allowing more time for a fuller analysis of its methodology and measures and to hear from stakeholders, including hospitals and health systems, about concerns found in many preview reports," AHA Executive Vice President Tom Nickels said in a statement.

The most significant change the CMS proposed for the July ratings was how safety measures were calculated in the overall rating. The safety domain, which is weighted at 22% in the overall rating, uses eight measures to calculate that score. In the December 2017 methodology, the patient safety and adverse events composite measure was given the most weight in the safety domain. In the proposed July methodology, the complication rate following elective hip and knee arthroplasty was given the most weight.

As Modern Healthcare previously reported, because of how the methodology is set up, hospitals that perform below average on safety or the three other heavily weighted measures—readmissions, mortality and patient experience—have to perform above average on the other three measures in order to get four stars or higher.

The CMS also made changes to the star ratings for the December 2017 release, particularly how it clusters hospitals together to get the overall rating. The change attempted to address concerns that hospitals in different star categories perform similarly.

Critics argue that the changes didn't address a fundamental problem with the star ratings: Hospitals with different patient populations and services are being compared to each other, skewing the results.

The agency said in an email that it's "dedicated to transparency of quality and cost information for consumers, and committed to holding providers accountable for patient outcomes. When changes are made to the underlying measures it is vital to take the time needed to understand the impact of those changes and ensure we are giving consumers the most useful information."