Blog

Hospital Ratings: Flawed but Necessary Tools to Gauge Hospital Quality

Millions of prospective patients depend on hospital rankings to help them decide where they seek treatment, and they have a lot of systems to choose from. US News and World Report, The Leapfrog Group, The Joint Commission, and CMS all offer unique rating systems covering multiple aspects of hospital care. So what should a patient do when the ratings conflict, and to what extent do they accurately reflect the care available? Recent events have brought issues with hospital ratings to light, suggesting that agencies are still working to refine and perfect their grading systems.

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HCAHPS: What Hospital Patients Care About the Most

August 1, 2017 BY Definitive Healthcare

Patient experience has taken on new importance in recent years due to new CMS quality and reimbursement initiatives. Today, many hospitals’ Medicare payments are determined in part by their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, a standardized program through which patients rate hospitals on 11 key measures. Two of the domains, the percentage of patients who scored their stay at 9 or 10 out of 10 and willingness to recommend the hospital, deserve some attention as they represent qualitative judgements of the entire patient experience. Given their importance to a hospital’s performance in some CMS programs and general reputation, it’s critical for hospitals to identify what specific aspects of a patient’s experience have the most influence on their overall ratings. An analysis of the most recent hospital HCAHPS scores suggests that not all measures have the same degree of correlation to a patient’s numeric rating and recommendation.

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CMS’ Blunt Solution to 340B Problems

July 25, 2017 BY Definitive Healthcare

Earlier in July, CMS issued a proposed rule outlining changes to the 340B program, an initiative through which qualifying hospitals can purchase outpatient drugs at a discount while receiving CMS payments for the average sale price plus a bonus. The rule dramatically cuts the reimbursements for certain drugs, attempting to achieve parity between actual drug costs and payments, though it removes a significant source of revenue for hospitals. Despite the outcry from hospital organizations and industry advocates, government studies suggest that the 340B program has significant flaws and that CMS and the Health Resources and Services Administration (HRSA) should act decisively to fix them.

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Comparing Care for Older Americans: Skilled Nursing At-Home or in Facilities

As the population of older Americans increases, the need for skilled nursing care and residential care facilities is on the rise. Depending on the care recipient’s ability and medical needs, care options can include home health agencies (HHAs), assisted living facilities (ALFs), or skilled nursing facilities (SNFs).

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Since its launch in 2014, CMS’ Value-Based Purchasing program has come under criticism for unfairly punishing certain hospitals, especially safety-net facilities that treat poorer and sicker patients. However, a less common complaint is that it may unfairly reward hospitals that have substandard quality. As a new GAO report on the program suggests, CMS’ scoring methodology poses unique problems, as it creates disincentives to fully participate to the benefit of hospitals which may not provide high-quality care.

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