Many Well-Known Hospitals Fail to Win Five Stars in Medicare’s New Ratings Scheme

Industry executives are displeased

The Centers for Medicare and Medicaid Services (CMS) has released its first overall hospital quality rating, giving average or below-average scores to many of the nation’s best-known hospitals while awarding top scores to many unheralded facilities, according to a report from Kaiser Health News.

The CMS rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make centers that treat the most difficult cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality.

Only 102 hospitals received the top rating of five stars, and few of them are considered to be among the nation’s best by private ratings sources, such as U.S. News & World Report, or are viewed as the most elite within the medical profession.

The CMS awarded five stars to relatively obscure hospitals and to a notable number of hospitals that specialized in only a few types of surgery, such as knee replacements. There were more five-star hospitals in Lincoln, Nebraska, and La Jolla, California, than in New York City or Boston. Memorial Hermann Hospital System in Houston and the Mayo Clinic in Rochester, Minnesota, were two of the nationally known hospitals that earned five stars.

The CMS awarded the lowest rating of one star to 129 hospitals. Five hospitals in Washington, DC, received a one-star rating, including George Washington University Hospital and MedStar Georgetown University Hospital, both of which teach medical residents. Nine hospitals in Brooklyn, New York, four hospitals in Las Vegas, Nevada, and three hospitals in Miami, Florida, also received one star.

Some premiere medical centers received the second-highest rating of four stars, including Stanford Health Care in California; Massachusetts General Hospital in Boston; Duke University Hospital in Durham, North Carolina; NewYork–Presbyterian Hospital and New York University Langone Medical Center in Manhattan; the Cleveland Clinic in Ohio; and Penn Presbyterian Medical Center in Philadelphia. In total, 927 hospitals received four stars.

The CMS gave its below-average score of two stars to 707 hospitals. They included the University of Virginia Medical Center in Charlottesville; Beth Israel Medical Center in Manhattan; North Shore University Hospital (now known as Northwell Health) in Manhasset, New York; Barnes–Jewish Hospital in St. Louis, Missouri; Tufts Medical Center in Boston; and MedStar Washington Hospital Center in Washington, DC. Geisinger Medical Center in Danville, Pennsylvania, which is a favorite example of a quality hospital among national health-policy experts, also received two stars.

Nearly half of the hospitals—1,752—received an average rating of three stars. Another 1,042 hospitals were not rated, including all of the hospitals in Maryland.

The CMS based its star ratings on 64 individual measures that are published on its Hospital Compare website, including death and infection rates and patient reviews. The CMS noted that specialized and “cutting-edge care,” such as the latest techniques to battle cancer, are not reflected in the ratings.

The government said in a statement that it has been using the same type of rating system for other medical facilities, such as nursing homes and dialysis centers, and has found them to be useful to consumers and patients. Those ratings have shown, the CMS said, “that publicly available data drive improvement, better reporting, and more-open access to quality information for our Medicare beneficiaries.”

In a statement, Rick Pollack, president of the American Hospital Association, called the new ratings confusing for patients and families. “Health care consumers making critical decisions about their care cannot be expected to rely on a rating system that raises far more questions than answers,” he said. “We are especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor.”

Source: Kaiser Health News; July 27, 2016.