Grading the Hospitals That Try to Heal Us

After a three-month delay, the Center for Medicare and Medicaid Services (CMS) released its hospital star ratings this week amid turmoil from the health care community. CMS originally planned to publish the ratings on medicare.gov in April but agreed to delay going public after 60 senators and 225 representatives sent the agency letters urging them to postpone.

The ratings provide data on more than 4,000 hospitals and other health care centers across the country. Yet some hospital administrations worry the ratings will unnecessarily damage their reputations.

“It seems CMS went through a careful process to develop the system and select the measures,” said one physician.

“Health care consumers who make critical decisions about their care cannot be expected to rely on a rating system that raises far more questions than answers,” said Rick Pollack, president of the American Hospitals Association (AHA), in a media release. “It adds yet another to a long list of conflicting rating and ranking systems.”

It’s true the CMS system isn’t the first of its kind. Other systems have been developed and published, including ones from U.S. News and World Report, Consumer Reports, HealthGrades, and the Leapfrog Group. An analysis of these ratings that was published in Health Affairs concluded “the complexity and opacity of the ratings is likely to cause confusion instead of driving patients and purchasers to higher quality, safer care.”

A big weakness is this: The different ratings compare different aspects of health care, such as patient safety or specialty. These differences are not always clear to consumers, and there is concern people could make snap judgments without complete understanding.

These systems are also not always transparent. The Leapfrog and Consumer Reports ratings help their customers understand the methodologies. HealthGrades and U.S. News do not.

On the other hand, the CMS system is completely transparent.

Because hospitals receive larger and larger portions of their reimbursements from CMS based on patient satisfaction, these ratings are a big deal.

Its ratings are published on the Hospital Compare site. It’s set up so that readers can type in their ZIP code and compare the ratings of different hospitals in their area. The tabs on the page include information on patient surveys, timeliness of care, complications, readmissions and deaths, use of medical imaging, and payment and value of care.

At first glance, it appears both thorough and helpful. And Dr. Patrick Romano, professor of general medicine and pediatrics at the University of California, Davis, seems hopeful. He contributed to the report in Health Affairs that evaluated the other ratings systems. “It seems CMS went through a careful process to develop the system and select the measures that are included,” Dr. Romano said. He notes the critics of the CMS ratings, such as the AHA, “had input in this process.”

“I’m an optimist,” Dr. Romano told LifeZette. “And I tend to think that markets work better with more information.” With more time, he believes, the different ratings will sort themselves out into inferior and superior systems.

[lz_bulleted_list title=”Overall Ratings for Hospitals” source=”http://www.medicare.gov”]5 stars: 102 (2.2%)|4 stars: 934 (20.3%)|3 stars: 1770 (38.5%)|2 stars: 723 (15.7%)|1 star: 133 (2.9%)|N/A 937 (20.4%)[/lz_bulleted_list]

Until then, Dr. Romano reserves judgment. “The CMS rating system is relatively new, and the research community hasn’t had the opportunity to evaluate it and compare it with others. I can ensure you we will.”

One hospital administrator in Los Angeles who requested anonymity said he sees the star rating as a good thing. While the stars are new, the Hospital Compare site has been around for years, he said.

He believes the ratings give “patients a lot of power to go to the health care system where they can receive the best care,” adding that the star ratings move health care “from a provider-led health care system to more of a team-based model.” And because hospitals receive larger and larger portions of their reimbursements from CMS based on patient satisfaction, these ratings are a big deal.

But involving the patient isn’t always easy, especially for those doctors who deal with patients addicted to opioids or other drugs. Patient satisfaction may not be an adequate representation of care in such cases because doctors have to regulate pain medications differently when they factor in addictions. And for many doctors already struggling with patient volume and CMS reimbursement, adding one more thing to the to-do list is taxing.

The ratings also do nothing to address the shortage of options for those patients in rural areas — these people cannot travel long distances to receive better care.

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At least one thing is clear: Patients have more information at their disposal and more autonomy about their health care than before. AHA has vowed to keep working with CMS to refine the ratings system so patients can be even more empowered.