By: Kate Goodrich, MD, MHS, Director of Center for Clinical Standards and Quality
When individuals and their families need to make important decisions about health care, they seek a reliable way to understand the best choice for themselves or their loved ones. That’s why over the past decade, the Centers for Medicare & Medicaid Services (CMS) has published information about the quality of care across the five different health care settings that most families encounter. These easy-to-understand star ratings are available online and empower people to compare and choose across various types of facilities from nursing homes to home health agencies. Today, we are updating the star ratings on the Hospital Compare website to help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side-by-side, and ask important questions about care quality when visiting a hospital or other health care provider.
Today’s ratings include the Overall Hospital Quality Star Rating that reflects comprehensive quality information about the care provided at our nation’s hospitals. The new Overall Hospital Quality Star Rating methodology takes 64 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars. The rating includes quality measures for routine care that the average individual receives, such as care received when being treated for heart attacks and pneumonia, to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections. Specialized and cutting edge care that certain hospitals provide such as specialized cancer care, are not reflected in these quality ratings.
We have received numerous letters from national patient and consumer advocacy groups supporting the release of these ratings because it improves the transparency and accessibility of hospital quality information. In addition, researchers found that hospitals with more stars on the Hospital Compare website have tended to have lower death and readmission rates.,
Prior to publishing the Overall Hospital Quality Star Rating, we paused to give hospitals additional time to better understand our methodology and data. In response, we delayed the release of the ratings. Since then, we have conducted significant outreach and education to hospitals to understand their concerns and directly answered their questions, including:
- Hosting two National Provider Calls with over 4,000 hospital representatives. During the calls, we walked through the Overall Hospital Quality Star Rating data and the methodology in detail while responding to questions that the attendees raised.
- Providing specialized assistance to hospitals. We held numerous meetings with the hospital associations and individual hospitals to explain their data and answer questions.
- Posting an evaluation of the national distributions of the Overall Hospital Quality Star Rating based on hospital characteristics. The analysis shows that all types of hospitals have both high performing and low performing hospitals.
- Subjecting the measures used to calculate the Overall Hospital Quality Star Rating to rigorous scientific review and risk adjustment. All of the measures used to calculate the Overall Hospital Quality Star Rating are based on clinical guidelines and have undergone a rigorous scientific review and testing. The vast majority are endorsed by the National Quality Forum. Most of these quality measures are already adjusted for clinical co-morbidities to account for the illness-burden of the population. Some hospitals have raised the question of making additional adjustments to account for the sociodemographic characteristics of the patients they serve. We continue to work closely with the National Quality Forum and the Assistant Secretary for Planning and Evaluation (ASPE), who is required by the IMPACT Act to study the effect of socioeconomic status on quality measures and payment programs based on measures. We will work with ASPE and determine what next steps, if any, should be taken to adjust our measures based on the recommendations in the report.
CMS will continue to analyze the star rating data and consider public feedback to make enhancements to the scoring methodology as needed. The star rating will be updated quarterly, and will incorporate new measures as they are publicly reported on the website as well as remove measures retired from the quality reporting programs.
Today, we are taking a step forward in our commitment to transparency by releasing the Overall Hospital Quality Star Rating. We have been posting star ratings for different facilities for a decade and have found that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries. We will continue to work closely with hospitals and other stakeholders to enhance the Overall Hospital Quality Star Rating based on feedback and experience.
These star rating programs are part of the Administration’s Open Data Initiative which aims to make government data freely available and useful while ensuring privacy, confidentiality, and security.
For more information please see https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-27.html.
 Wang DE, Tsugawa Y, Figueroa JF, Jha AK. Association Between the Centers for Medicare and Medicaid Services Hospital Star Rating and Patient Outcomes. JAMA Intern Med. 2016;176(6):848-850. doi:10.1001/jamainternmed.2016.0784. http://archinte.jamanetwork.com/article.aspx?articleid=2513630
 Trzeciak, S. Gaughan, J. Mazzarelli, A. Association Between Medicare Summary Star Ratings and Clinical Outcomes in US Hospitals. Journal of Patient Experience. 2016 vol. 3 no. 1 2374373516636681 doi: 10.1177/2374373516636681 http://jpx.sagepub.com/content/3/1/2374373516636681.abstract