CMS uses quality metrics to revamp hospital ratings system

Agency releases star-rating approach, despite requests for delay by AHA, Congress.


The Centers for Medicare and Medicaid Services has updated its star-rating feature on the Hospital Compare website to better enable consumers to conduct side-by-side comparisons of hospitals.

CMS has taken 64 quality measures already being reported on the Hospital Compare site and summarized them into a unified rating system that gives rankings of from one to five stars, the agency announced. But while CMS delayed release of the ratings at the request of hospitals to better understand concerns, the American Hospital Association is not impressed with the final results.



In a statement, AHA said the new program is confusing for consumers and “adds yet another to a long list of conflicting ratings and rating systems.” The association also notes that 60 members of the Senate and 225 members of the House of Representatives called for a delay until the ratings system could be improved.

“In addition, we are especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor,” according to AHA. “We are further disappointed that CMS moved forward with release of its star ratings, which clearly are not ready for prime time.”

Hospitals are assessed a rating based only on the measures for which they submit data, which includes Medicare beneficiary data and some data from the general patient population regardless of the payer.

“For example, measures on deaths, readmissions and use of medical imaging include data from Medicare beneficiaries only,” according to CMS. “The patient experience, safety, and timely and effective care measures include data from any adult patient treated at hospitals.”

The Hospital Compare ratings of patient experiences cover communication with nurses, communication with physicians, responsiveness of hospital staff, pain management, cleanliness and quietness of the hospital environment, communication about medications, information on what patients should do and what help they may need during recovery at home, and an overall rating.

CMS appeared to be ready to defend the new system in its announcement, explaining its outreach to hospitals. This included hosting national calls with providers with more than 4,000 hospital representatives, meeting with associations and individual hospitals to explain the data and answer questions, sharing analysis of hospital characteristics showing that all types of hospitals have both high-performing and low-performing hospitals, and calculating overall ratings based on clinical guidelines with rigorous scientific review and testing. The National Quality forum, CMS said, endorsed the vast majority of guidelines.

A CMS spokesperson was not immediately available to respond to criticism from the AHA.

Other CMS star rating programs cover nursing homes, physician practices, dialysis, home health and a Medicare Plan Finder that Medicare carriers offer to help consumers compare health plans.

The revamped Hospital Compare web site is here. More information on the hospital ratings is available here.

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