5 things to know about CMS’ latest hospital star ratings

This year, the Centers for Medicare and Medicaid Services’ hospital star ratings included more COVID-19 pandemic data from late 2021 and early 2022, giving the industry a broader look at how facilities performed during that time on key measures of safe and effective care.

Across peer groups and facility types, around 8% of the 3,076 hospitals CMS rated received one star, 22% got two stars, 28% got three stars, 26% earned four stars and 16% got five stars.

Here are five takeaways from the ratings released in July.

1. Generally, hospitals didn’t see much fluctuation in their scores. Nearly half of hospitals kept the same rating between 2022 and 2023. Of the 28% that saw a decrease and the 24% that saw an increase, the majority only lost or gained one star.

While the overall ratings distribution has remained roughly the same as well, this year acute-care hospitals saw slightly higher percentages of one-star and five-star ratings compared with 2022.

2. Pandemic-related exceptions and process changes led to more balanced metrics. For the 2023 scores, CMS continued to exclude data from the first half of 2020 in an attempt to offset negative impacts from the early months of the pandemic on hospital performance. The agency added a metric covering COVID-19 vaccination among healthcare workers to its "timely and effective care" measure group.

3. Veterans Health Administration hospitals received top marks. While VHA hospitals regularly report data for measures included in star ratings, this is the first year the facilities have been eligible to get rated individually. Approximately 32% of VHA hospitals received five stars, compared with 21% of critical-access hospitals and 15% of acute-care hospitals.

4. Hospital performance reflects safety and reimbursement priorities. Because certain star rating measures--like readmissions and hospital-acquired infections--are directly tied to reimbursement, many hospitals have continued to prioritize safety and quality efforts over the past few years, said Rick Kes, a healthcare senior analyst at consultancy RSM.

“Despite all the headwinds and the staffing challenges, the COVID-19 emergency and massive increases in expenses, you're not seeing a ton of hospitals fall off the radar when it comes to star ratings,” he said.

Higher star ratings are also beneficial from a marketing perspective for hospitals that want to stand out in their communities, Kes said.

5. Stakeholders continue to push for more contemporary metrics. Following the major changes CMS made to its star rating methodology in 2021, including stratifying hospitals by the number of measure groups reported and eliminating 12 metrics, some hospital leaders say room for improvement remains.

CMS should continue listening to public feedback about its metrics and include new measures that address additional safety and quality concerns, said April Taylor, chief operating officer at Johns Hopkins Hospital in Baltimore.

“A next step may be to look at, ‘Are there more inpatient measures related to timely and effective care that might be appropriate for the star rating?’ ” Taylor said.