|To:||Patient Safety Committee
Hospital Quality Leaders
Public Relations Leaders
|From:||Carol Wagner, Senior Vice President for Patient Safety
Mary Kay Clunies-Ross, Vice President for Membership and Communications
|Subject:||Overall Hospital Quality Star Ratings from CMS|
The purpose of this bulletin is to ensure hospitals are aware that the Centers for Medicare and Medicaid Services (CMS) will be adding an overall hospital “star rating” to Hospital Compare. The new rating will be part of the April update to the site.
Hospitals reporting to Hospital Compare will receive a star ranking from CMS based on 57 measures from the inpatient quality reporting (IQR) and outpatient quality reporting (OQR) scores.
WSHA recommends that hospitals know their star rating (using the CMS QualityNet portal) and be prepared to explain it to internal and external audiences. This is especially true of those that are safety net hospitals or in large urban centers where the scores are generally lower compared to rural communities.
CMS will place 57 measures from the IQR and OQR programs into seven groups: mortality, safety, readmissions, patient experience, timeliness of care, effectiveness of care and imaging efficiency.
The national distribution of the star ratings is as follows:
- 1 star – 142 hospitals (3.9%)
- 2 stars – 716 hospitals (19.6%)
- 3 stars – 1881 hospitals (51.6%)
- 4 stars – 821 hospitals (22.5%)
- 5 stars – 87 hospitals (2.4%)
WSHA and WSHA members have a long standing commitment to transparency around quality, and helping patients and the public understand what the data means. However, oversimplifying complex information can lead to the wrong conclusions, so it’s critical that the underlying data be examined as well.
Here are several points that may be helpful in understanding and explaining the new scores.
- WSHA and its member hospitals strongly support patients’ access to quality data, which is why we brought together many different datasets to WAHospitalQuality.org. WSHA includes CMS’ star rating for patient satisfaction scores.
- When developing WAHospitalQuality.org, we also tried to find a way to provide a simple “roll up” score. However, we found that combining and weighting different kinds of scores— such as labor and delivery, heart attacks, infection rates, readmissions, knee replacements and patient satisfaction— did not produce useful information. Individually, it’s important data, but it doesn’t consistently combine well in a way that is meaningful for all patients.
- Another challenge is that not all hospitals provide all of the services included in the CMS scores, which weakens the value of an overall rating.
- Hospitals that provide safety-net services tend to have worse averages because it’s very hard to counterbalance the complexity of the patients they see. For example, a greater percentage of their patients are unhealthy and may come in with significant infections, which leads to worse average scores—even if the outcomes for healthy patients are better than at neighboring hospitals.
- We strongly believe that patients should learn all they can about the quality of the health care choices available to them in their area and under their health plan.
- A star system would be more valuable to the public if it were focused on individual conditions, such as cardiac or orthopedics, as opposed to combining various unrelated conditions.
Background and References
- Bulletin from the American Hospital Association
- Modern Healthcare January article