Magnifying glass on the word quality


Websites and shopping apps including Amazon, Ebates and ShopSavvy take full advantage of every consumer’s desire to find a good deal. Price comparisons, coupons and reviews provide a sense of confidence for making the best purchase.  Similarly, healthcare consumers can be influenced on their choice for healthcare services by viewing Medicare’s Hospital Compare, which provides an overall star ratings from one to five based on a summary of various quality measures.

While a star rating is a simple concept for the consumer, these ratings represent a complex set of measure types covering a broad set of clinical conditions and care processes.  The Overall Hospital Quality Star Rating on Hospital Compare: February 2019 Updates and Specifications Report provides full details on the methodology used by the Centers for Medicare & Medicaid Services’ (CMS) Overall Hospital Quality Star Rating to summarize existing quality measures data into a useful and easy to interpret format for consumers.

Nancy McDonald, RN, BSN, CPHQ - Director of Quality Improvement“Achieving a high star rating is a priority for hospitals to maintain their reputation and instill confidence in the care they provide to their community members,” explained Nancy McDonald, RN,BSN, CPHQ, director of quality improvement for the Great Plains Quality Innovation Network (QIN). “For the smaller community hospitals, their reputation for providing quality care and positive patient experiences may be the competitive edge against the bigger regional systems for keeping care local.”

Hospital specific reports (HSR) provide the quality measure data and are released two times a year.  Great Plains QIN provides assistance to review the HSR, identify measures impacting the star ratings and provide technical assistance for quality improvement efforts.

“When the reports are released, many facilities already have teams in place to quickly address findings and zero in on areas that need attention,” McDonald commented. “Focusing efforts on one key quality category can impact the overall star rating a hospital may receive.”

Star ratings are calculated from 100 different eligible measures based on seven different quality measure groups:  mortality, readmissions, safety of care, patient experience, timeliness of care, effectiveness of care and efficient use of medical imaging.  The large quantity of measures can make determining that one high-impact category complicated and time-consuming.

Some critics argue that variations in patient populations and healthcare service offerings among hospitals may skew overall star ratings. For example, critical access hospitals (CAH) in medically underserved areas are directly compared with specialty hospitals providing elective services.

Modern Healthcare’s December 2018 issue included an article titled New CMS star ratings ignore socio-economic factors, which stated,  “Hospitals with a high percentage of dual-eligible stays do worse than other hospitals in the readmissions category of the CMS star ratings, hurting their overall star rating,…”

“While the star rating encourages hospitals to improve quality of care and provides guidance to consumers, it can also create an altered perception when chronic conditions or social determinants aren’t considered,” reflected McDonald.

During the 2019 CMS Quality Conference, McDonald attended a session titled “Overall Hospital Star Rating – Voices from the Field”, where speakers hinted at future capability for hospitals to predict their star rating.

“The current system prevents hospitals from projecting a star rating. Including social determinants would contribute to a more balanced comparison for specialty hospitals, CAHs and teaching hospitals,” McDonald commented. “Supporting hospitals to achieve star ratings that properly reflect the quality of care provided directly relates to the Great Plains QIN vision to make health in our region the best in the nation.”