Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Safety & Quality
March 02, 2019 01:00 AM

Hospitals hopeful big changes are coming to the CMS’ star ratings

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

    Hospitals have for years been advocating for overhauling the CMS’ star-rating program. They may finally get their wish.
    The agency is seeking public input on a comprehensive list of potential changes to the program, including tossing out the long-standing model used to assign ratings.

    In the 48-page document, the CMS acknowledged virtually all of the most common complaints pitted against the star ratings since they were first released to the public in July 2016. Perhaps the most surprising is the thought of replacing the latent variable model with another approach. The suggestion—tucked deep within the document—is a change in course for the agency and gives hospital leaders hope the agency is interested in meaningful reforms.

    “It seems like they are really trying to adopt the recommendations,” said Dr. Bala Hota, chief analytics officer at Rush University Medical Center in Chicago. “We have been really involved for over a year (talking to the CMS about the star ratings and the model), and it appears they are listening.”

    The latent variable model was designed by the CMS with help from Yale New Haven Health, which has a $83.5 million contract with the agency to develop and maintain the star-rating program along with other tasks.

    In the document, which was prepared by Yale New Haven, the CMS said it’s considering “replacing LVM (the latent variable model) with an explicit approach (such as an average of measure scores) to group score calculation.”

    The CMS called it a “long-term” consideration that wouldn’t be applied until 2020 quality reporting and beyond.

    It’s a left turn from July 2018 when a CMS agency official defended the latent variable model in an interview with Modern Healthcare even after it was heavily criticized by hospital groups. Hospital leaders blamed the model for drastic changes they saw in their star ratings from December 2017 to July 2018 that eventually led to the 15-month hiatus for ratings updates. The newest scoring was also released last week, with modest shifts in overall ratings.

    In response to a question from Modern Healthcare about the change in course, a CMS spokesman said, “CMS appreciates the stakeholder feedback we’ve received on this particular statistical model and looks forward to additional feedback on the model.”

    But hospital stakeholders and analysts said throwing out the model is an essential step to truly improve the star ratings.

    “Moving away from the latent variable model and having a transparent weighing of the variables is foundational; it’s a key step,” said Dr. David Levine, senior vice president of advanced analytics and informatics at consultancy Vizient. “Of the suggested changes in the lengthy document, it’s one of the musts and it makes those other areas much more meaningful.”

    The latent variable model is a statistical approach that gives more emphasis to certain measures over others based on a number of aspects, including variation in performance among hospitals for that measure or how much measures correlate to each other.

    The CMS doesn’t decide how much weight is given to each measure; instead the model does it on its own. Because of this, the star ratings have been unpredictable, said Nancy Foster, vice president of quality and patient safety at the American Hospital Association. 

    In the July 2018 preview of the ratings, the latent variable model gave much more emphasis to hip and knee complication rates in the safety-of-care domain instead of the PSI-90 measure, which received the most emphasis in that domain in previous iterations of the ratings. 

    Unless the CMS removes such unpredictability, any other changes made to the program are unlikely to have a significant impact, Foster said.

    “We think we know what might help, but unless you plug it through the latent variable model you don’t know if it’s going to do what you think it will,” she said. 

    The CMS also wants feedback on whether it should separate hospitals into peer groups, group measures differently, and release the ratings once a year. Comments are due by March 29.

    Instead of the latent variable model, the CMS suggested assigning weights to each measure in the domains. There are currently 57 measures separated into seven domains that make up the total rating.

    The agency said it would ask for stakeholder feedback to determine how the measures should be weighted, acknowledging that getting consensus “might be difficult to achieve.”

    Maryellen Guinan, senior policy analyst at America’s Essential Hospitals, said she’s concerned that the CMS’ weights could prioritize some measures over others that stakeholders don’t agree with.

    “You can see there are issues in terms of potentially unintended consequences,” she added.

    While there is potential for disagreements, the process will be much more transparent than how it’s now, Hota suggested. “Right now, you have a statistical black box telling you the weights,” he said. “Having actual patients and experts telling you what the weight should be, that’s a much more democratic process.”

    Hota and his Rush colleagues have been vocal about their issues with the star ratings, recently publishing a blog post that laid out their concerns.

    In addition to potential changes to the latent variable model, Hota and others were also excited about the possibility that the star ratings could eventually be customized by users depending on their specific health needs. “I feel like we are at an inflection point where we are moving beyond these blunt measurement instruments and getting more precise,” Hota said.

    The CMS said it would like feedback from stakeholders on creating a tool that would allow consumers to set their own weights for each of the seven measure groups used in the star ratings.

    Dr. Mark Friedberg, a senior physician policy researcher at RAND Corp., said a customized tool for consumers is likely the future of healthcare rating sites but the industry isn’t there now.

    “We don’t know how to do this yet,” he said. “It’s probably years away to get to a prime-time-ready version of this. It would be great if they (the CMS) take it up as a long-term goal.”

    Friedberg, who created a mock webpage that allows the user to change the weights in the CMS star ratings, said it will require educating consumers about what they should care about for their condition.

    Hota added that a customized tool would ideally have more precise measures, and he doesn’t think that’s far off. He pointed to efforts by the CMS to open patient data including the proposed rule last month that would require health plans to provide enrollees with access to medical information. The rule would also make public the names of providers that block patient information from insurers.

    Open data-sharing may lead to much more precise, disease-specific measures that the star ratings now lack, Hota said.

    “I feel like a real long-term plan is more personalized measures that help me with the things I’m struggling with, and not a one-size-fits-all approach,” he added.

    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
    Cleveland-clinic-for web_i.jpg
    Increase in hospital police forces brings criticisms, warnings
    home-infusion
    Rise in home infusion therapy leads to questions on safety, cost
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Get Newsletters

    Sign up for 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
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

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

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    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 © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing