The Medicare Payment Advisory Commission joined critics of CMS’ Overall Hospital Quality Star Rating system, stating in a letter addressed to Administrator Andy Slavitt that the program doesn’t grade every hospital in the same way.
In order to receive a star rating, hospitals must report on at least three of seven quality measures such as readmissions and mortality. Not all measures are weighted equally towards a hospital’s overall score, with more emphasis given to outcomes-based rather than process-based measurements. According to MedPAC’s analysis, hospitals with five-star ratings for quality were often assessed on fewer outcomes measures than hospitals with one-star ratings, suggesting that limited or missing data inadvertently boosted organizations’ scores compared to those that reported more information.
Hospitals by Star Rating, Selected Characteristics
|1 Star (126)||2 Star (704)||3 Star (1738)||4 Star (919)||5 Star (102)|
|All-Cause 30-day Readmission Rate||0.170||0.162||0.156||0.150||0.141|
|Patient Satisfaction Score||2.1||2.5||3.2||3.7||4.2|
|Total Hospital-Acquired Condition (HAC) Score*||6.6||5.9||5.3||5.0||4.2|
Data from Definitive Healthcare
*Scale of 1 to 10, lower is better
MedPAC also echoed concerns previously raised by other observers and health organizations that the system does not properly account for differences in patient health and intrinsic risk between hospital populations. According to MedPAC and others, the star rating system unfairly penalizes hospitals that treat less healthy patients with more severe conditions.
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