Here's how consumers and providers can get a better CMS star ratings system

Here's how consumers and providers can get a better CMS star ratings system
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The Overall Hospital Star Rating system from the Centers for Medicare & Medicaid Services (CMS) was meant to give consumers an easy way to pick the best hospitals for them and loved ones.

Yet the rating system for more than 4,500 hospitals nationwide does not always provide consumers with the full picture. Updates to the rating methodology made in December are a positive step, but they don’t go far enough.

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Here are five recommendations to help the star rating earn five star reviews from the consumers it is trying to serve.

 

Smarter hospital groupings

Despite the best intentions of CMS to provide a simple, baseline quality metric of hospitals for consumers, it’s not always a fair measure. It unfairly lumps together community hospitals, large health systems, specialty hospitals and teaching/academic hospitals on many key metrics, like mortality. 

CMS should instead cluster hospital types so hospitals treating advanced cancers, neurosurgical cases, and cardiology cases are compared to each other. Hospitals that treat general medicine and surgical cases should be in a separate group.

Critical access hospitals should also be grouped together and separate from community hospital and separate from comprehensive treatment centers. This stratification would help make comparisons based on the star rating more accurate and fair for providers and more relevant to consumers.

Group primary procedures by specialty

Because the current star rating does not differentiate between various specialties, consumers do not have a clear view of a hospital’s rating for a specific need. For example, a consumer facing a knee replacement surgery wants the best hospital for knee replacements, not the best heart center.

Instead, similar hospitals should be grouped together and offer more details on specialty procedures.

Use better data, faster

The CMS should use more timely, relevant data to minimize misperceptions of current hospital performance. Based on research at Vizient, about 64 percent of the overall star rating score is measured with data that is at least two years old.

Consumers need near real-time performance data, and CMS can also do more to tap its trove of data to be more timely and relevant. Another major limitation to the current utility of the ratings is that it is based only on Medicare patients, a smaller subset of hospital patients the hospital takes care of.

Create data transparency

In addition to speed, having more transparent and usable data in the star rating are key. Imagine scoring a 70 on a final exam and never knowing what you did wrong so you could learn and improve the next time? Providers trying to understand their rating face this very issue.

It is unclear from the current rating system what major areas hospitals should focus on to improve care. Data transparency within the ratings makes it hard to identify specific patient safety events to focus on or a specific specialty that needs improvement.

The ratings should be more than a report card. They should also be a tool to guide performance improvement. As it stands, it’s impossible to draw meaningful and accurate conclusions about the quality of care for hospitals, physicians and the patients they serve.

Revise the weighting of measures of quality

The importance CMS currently places on the four key criteria used to calculate the star rating — patient safety, patient experience, readmission and mortality risk — should be reconsidered.

These four criteria each are worth 20 percent of the total score, with some other measures receiving less attention. While these are the right buckets, they do not tell a complete and accurate story about quality. The weighting should be adjusted to give greater merit to criteria like effectiveness of care and timeliness of care.

Also, a better system needs to be put in place for hospitals that do not have enough volume to report on a specific metric. Currently in these cases, the metric is not counted and the remaining metrics are weighted higher. For example, specialty hospitals only report half of the current parameters, but they’re still included in the Star Ranking with comprehensive hospitals.

This results in hospitals being compared against each other but not all the same metrics or relative weights of the metrics are being used. It may appear that a hospital with 5 stars is better than the 4 star hospital but they were compared differently. A better approach would be to cluster hospitals, as noted earlier, to create a more fair and useful comparison.

The star rating system is a great idea. With the tweaks outlined here, it can become a positive feedback loop between hospitals, physicians and patients to drive performance improvement.

David Levine, MD, is the senior vice president of Advanced Analytics and Informatics, Vizient. Vizient participates in the HIIN and TCPI which are both CMS funded programs. Levine also serves on the CMS Hospital Harm Technical Advisory Group.