The CMS is considering several changes to the methodology it uses to determine hospital star ratings, but some healthcare experts are concerned that the proposed changes don't really account for patient needs.
While hospitals and policymakers debate the CMS' proposed changes to the star quality rating methodology, the needs of patients have been cast aside, according to members of the CMS Advisory Panel on Outreach and Education during their meeting on Thursday. The CMS is considering several changes that it hopes will simplify the methodology, make star ratings more predictable over time and make it easier to compare hospitals.
But the panel's experts were concerned that the changes wouldn't help consumers make informed decisions about where they should seek treatment because many of them don't have a choice about where they receive care. Rural communities often have just one hospital, so quality ratings aren't particularly useful for making healthcare decisions. The same goes for people who are seeking emergency treatment and don't get to choose where an ambulance takes them.
"If you have one hospital, you have one hospital," said Cheri Lattimer, executive director of the National Transitions of Care Coalition.
Likewise, people with Medicare Advantage plans, Medicaid or other insurance with limited networks may only have access to certain hospitals. Doctors' admitting privileges limit patient choice too.
Many people won't use the star quality ratings, even if they have a choice, because it's too complicated for patients to know what the ratings mean. Members of the advisory panel were concerned that the ratings were too opaque for most consumers to understand because they lacked more granular information that consumers might find helpful like real-world patient experiences.
Several panelists said they didn't understand or use the ratings themselves, and many hadn't looked at them in years. They longed for something along the lines of Yelp or Amazon reviews but acknowledged that it would be tough to do and that hospitals would fight it tooth and nail.
"In order for people to use a star rating system, they have to find it credible," said Julie Carter, senior federal policy associate for the Medicare Rights Center.
The panel raised concerns about the ability of hospitals to game or abuse the quality ratings for their own purposes. They were especially worried about multi-hospital health systems advertising the rating of their highest performing hospitals, even if some of their hospitals didn't meet that standard. Health systems usually report to the CMS under a single CMS certification number, which can mask the performance of a low-performing hospital and make all the systems' hospitals look better than they are.
The CMS should further regulate the use of hospital star quality ratings to prevent hospitals from "riding the coattails" of higher-performing hospitals within their health system, said Cathy Phan, business development coordinator for the Asian American Health Coalition. That would increase transparency for consumers, she said.
Several members were also concerned that the CMS is considering adjusting for social risk factors. While risk adjustment can make it easier to compare hospitals, some panelists were concerned that the CMS' measures were too blunt or could create disincentives for hospitals to improve. They were especially worried that hospitals with a high number of low socioeconomic patients wouldn't invest as much in preventing readmissions if they got a break in the ratings for serving higher-risk patients.
"Please don't adjust for social risk," said Scott Ferguson, director of care transitions and population health for Mount Sinai St. Luke's Hospital. "The entire purpose behind the readmission penalty system was to get us to pay attention."