Another pain point for hospitals is CMS’ decision to stick with the same contractors to lead the modification work. Yale New Haven Health Services Corp. and Lantana Consulting Group have contracted with the CMS from the beginning on the star ratings and some hospitals argue they have been reticent to change the methodology despite widespread criticisms.
“Yale can still be the contractor … but they need to be willing to work with us; and I would say Yale is entrenched and that is unfortunate and that is my concern,” said Dr. Janis Orlowski, chief healthcare officer of the Association of American Medical Colleges.
Yale New Haven helped the CMS develop the latent variable model, a statistical approach that determines how much emphasis is given to the measures. The model has since been panned after it was blamed for significant changes hospitals saw in their ratings in July 2018, which caused a 14-month delay in releasing the next batch of ratings.
Yale researchers contend that they are open to change and critics should direct their ire at the CMS. “If people have specific concerns about our work, then we are eager to hear them. If they have specific concerns about star ratings and its direction, then they would be best served to address CMS,” Dr. Harlan Krumholz, director of the Yale Center for Outcomes Research and Evaluation, which works on the star-rating contract with the CMS, wrote in an email to Modern Healthcare. Yale also “requested” soliciting public comments on potential methodology changes, according to a CMS document, suggesting a willingness to make modifications.
More transparency about why the CMS opted to continue working with Yale could ease some concerns, Hota said.
The CMS “had an opportunity potentially to say, ‘Here is our process and how we selected the group that is going to do this work,’ ” he said. “It’s a natural tendency to feel skepticism about how much these methods will change when it is the same group doing the evaluation.”
Krumholz said Yale competed with other groups for its newest CMS contract. The work is part of a five-year, $71.7 million contract that began in April. Lantana Consulting Group has a contract with the CMS for $13.5 million.
“At the end of the day this is CMS’ rating system and regardless of the contractor, it’s their decision about how to drive things forward,” said Akin Demehin, director of policy at the American Hospital Association.
The agency’s recent hiring of Dr. Michelle Schreiber is encouraging some optimism about the agency’s intentions. Schreiber is now the CMS’ director of quality measurement and value-based incentives group, but most recently served as chief quality officer of Henry Ford Health System, where she spoke about the flaws in the star-rating system.
“We are hopeful she can provide that new fresh set of eyes and maybe push Yale to be a little bit more open going forward,” said Phoebe Ramsey, senior regulatory analyst of quality and payment policy at the AAMC.
In addition to the latent variable model, stakeholders complain about the lack of socio-economic risk adjustment and the absence of peer grouping.
Changes to the ratings program will be proposed through public rulemaking some time next year, according to the agency. Feedback from the recent public input request and insights from a technical expert panel will help guide changes.
The CMS asked hospital quality leaders, statisticians, measurement developers, consumers and purchasers to apply to be part of the panel. Yale is involved in selecting panel members, not the agency, according to the CMS spokeswoman.
Rush University, one of the most vocal critics of the current methodology, has applied to have one of its representatives on the panel. The application period ended Aug. 19.
The extent of changes made will be contingent on how much power is given to the technical expert panel, Hota said. “That group should be empowered to guide Yale on how this gets done,” he said. “Unless that happens, I’m skeptical we will see much change.” He added that the panel should have individuals who have never sat on a star-rating panel before so the agency can hear different opinions.
Along with the technical expert panel, the CMS will host a listening session on Sept. 19 to discuss the comments from the public input request. The agency wants providers, patients, patient advocates and quality measurement experts to attend.