The American Hospital Association supports only three of the 14 potential changes the CMS is considering for the hospital star ratings.
In response to a CMS request last month for public feedback on possible changes to the controversial star ratings program, the AHA said in a letter to the agency Wednesday that it approves of three proposed changes: replacing the current methodology, separating hospitals by peer groups and establishing a new criteria to group quality measures.
The AHA said all the other potential changes outlined in the CMS' 48-page public input request "either fail to address important shortcomings with star ratings, or simply do not have enough information for us to judge their impact."
The hospital lobbying group also renewed its call for the CMS to remove the star ratings currently posted on Hospital Compare.
"Unless and until the ratings methodology is improved, it will be difficult for hospitals and the public to have confidence that star ratings portray hospital performance accurately," the AHA said.
In the letter, the AHA said CMS' suggestion to replace the latent variable model with "an explicit approach...may be the most promising long-term option for improving star ratings."
The latent variable model is a statistical approach the CMS uses in the star ratings that determines how much emphasis each measure used to make up a hospital's overall star rating is given. The model was designed with help from Yale New Haven Health Services as part of a multi-million dollar contract with the CMS.
The AHA—and other hospitals and analysts—have cited the latent variable model for sudden changes hospitals see in their star ratings.
A potential replacement the CMS suggested is assigning weights to each of the measures used in the ratings instead of allowing a model to assign the weights.
AHA appeared to support the suggestion, stating the CMS could survey patients to figure out what measures are most important to them.
While AHA supported peer grouping hospitals, they called it a "short-term strategy" to fix the differences in star ratings between safety-net providers and other hospitals. Instead, the group said improvements to risk adjustment of the existing measures would be a better solution. "Direct risk adjustment would help improve the precision of performance comparisons by ensuring that measure scores reflect the issues most relevant to each measured outcome," the AHA said.
Finally, AHA said it supports changing the criteria the CMS uses to divide the measures in the star ratings into seven groups: mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care and efficient use of medical imaging. It also supports changing the weights applied to the measures in each of the groups, particularly calling out the weighting in the safety of care and readmissions groups. The PSI-90 measure is currently the most heavily weighted measure in the safety group and the hospital-wide readmissions measure is most heavily weighted in the readmissions group.
"There is no reason to believe it is appropriate for the PSI-90 measures or the hospital-wide readmissions measure to be so disproportionately weighted in the calculation of star ratings such that they drown out the effect of other better – or at least equally good – measures in the safety and readmissions domains," the AHA said.
The comment period ends on Friday.