Star Rating: Attractive, but ultimately not enough

July 28, 2016

Yesterday, the Centers for Medicare & Medicaid (CMS) released its long-awaited star quality ratings. These ratings are intended to combine a wide variety of quality measures into a single, consumer-friendly score.

From a consumer’s point of view, a 5-star rating is terrific. With hundreds of quality measures (many available on, a single star rating is easy to understand and talk about. It’s used for hotels, plumbers, restaurants, accountants, industrial cleaners and more. And when you’re navigating an injury or illness, any amount of simplification is welcome.

But applying a 5-star rating to a hospital is too simple because it combines too many unrelated services into a single score. Combining knee surgical infection rates with early elective delivery rates (and other rates) is like adding up all the Yelp scores for all the hotels, plumbers, restaurants, accountants, industrial cleaners in town, and then giving an average score to the entire city. Austin gets 3 stars, Indianapolis gets 2 stars, Tampa gets 5 stars.

Combining all those services into one overall number actually hides the information that’s truly relevant to individual consumers.

That’s why when we developed, we provided all the measures so patients could find the information most relevant to them. WSHA strongly believes in publicly sharing quality and safety information, which is why we built and maintain the site. But each individual patient is different, and that’s why we also strongly encourage patients to talk to their health teams about where to get the right care for them.

Besides the fact that the star ratings obscure the relevant quality measures, they also don’t account for one of the most important factors: how healthy the patient is. Hospitals that serve wealthier and healthier patients don’t automatically have higher scores, but they have a better chance of getting them. Their patients are more likely to have easier treatments and the resources needed to make faster recoveries. But hospitals with a large number of low-income patients, or patients with underlying health conditions are going to have lower averages– even if those hospitals actually have superior outcomes for healthy patients.

A star rating is an attractive consumer tool, but in the current form, it fails to give patients information they can base their decisions on. We sincerely hope that the star rating will evolve to provide better information in the future. In the meantime, we will continue to maintain our website and encourage patients to talk to their physicians about how to evaluate the right care for them.


Carol Wagner
Senior Vice President for Patient Safey


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