Conversation regina e-herzlinger phd new individual market horizon

The Centers for Medicare and Medicaid Services (CMS) has been posting quarterly hospital quality star ratings based on patients’ experience of care on the Hospital Compare website since April 16, 2015. According to a July 21 announcement, the agency intends to release its most-recent star ratings for individual hospitals “shortly.”

The star rating system takes 62 quality measures reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars. The ratings range from quality measures for the routine care an individual receives when being treated for heart attacks and pneumonia to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections.

The CMS recently published data showing the national distribution of overall hospital star ratings based on hospital characteristics. For each characteristic, such as teaching status or safety-net status, the CMS evaluated the distribution of hospitals across the five star categories.

The agency used hospital data from the July 2016 star ratings input file and defined the hospital characteristics based on the 2013 American Hospital Association annual survey of hospital characteristics and on the 2016 CMS IMPACT file, which is used for determining whether a hospital is eligible to be a disproportionate-share hospital (DSH). A total of 4,599 organizations were evaluated.

The CMS’s analysis shows that all types of hospitals have both high-performing and low-performing institutions. A total of 102 hospitals (2.2%) had a five-star rating; 934 (20.3%) had a four-star rating; 1,770 (38.5%) had a three-star rating; 723 (15.7%) had a two-star rating; and 133 (2.9%) had a one-star rating. A total of 937 hospitals (20.4%) did not meet the minimum measure/group reporting thresholds and did not receive star ratings.

Hospitals of varying bed size had similar mean star ratings (3.29 for one to 99 beds; 2.96 for 100 to199 beds; and 2.81 for 200 or more beds). The average mean star rating for teaching hospitals (2.87) was similar to but slightly lower than that for nonteaching hospitals (3.11). The CMS also found that the mean star rating for safety-net hospitals (2.8) was similar to but slightly lower than that for non–safety-net hospitals (3.09).

The CMS reported a lower mean star rating among DSH payment-eligible hospitals in comparison with non-DSH payment-eligible hospitals (2.92 vs. 3.47, respectively). The average star rating was higher among critical-access hospitals than among non–critical-access hospitals (3.31 vs. 2.99, respectively).

The star-rating system has drawn opposition from some stakeholders. In early July hospital groups called on the CMS to postpone publishing the ratings for a second time, saying that they were calculated in a way that would not accurately reflect a hospital’s quality. At that time, the CMS indicated that it might delay the ratings’ publication beyond July.

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