Lawmakers criticize calculations
Responding to concerns raised by hospitals and a majority of House and Senate lawmakers, the Centers for Medicare and Medicaid Services (CMS) has announced that it will delay until July the public release of an overall hospital quality star rating, according to a report from the American Hospital Association. The ratings were originally scheduled to be announced on April 21.
“The delay is a necessary step as hospitals and health systems work with CMS to improve the ratings for patients, and the AHA commends CMS for its decision,” said AHA President and CEO Rick Pollack. “Health care consumers need reliable, factual information to make critical care decisions. We will continue to share our concerns with CMS as we look for ways to make changes to the ratings system, and ensure it is useful and helpful for patients.”
On April 18, 225 members of the House of Representatives urged the CMS to delay the release of the quality ratings “to provide the necessary time to more closely examine the star rating methodology, analyze its impact on different types of hospitals, and provide more transparent information regarding the calculation of the ratings to determine accuracy.”
“We are concerned that the hospital star ratings, in their current form, may be unfairly masking quality or, possibly, over-weighting of patient experience measures and will therefore not help consumers make well-informed decisions about which hospitals to use,” the letter stated. “A number of the quality measures that underpin the ratings unfairly impact teaching hospitals that treat low socioeconomic status patients, more complex patients, and perform a greater number of complicated surgeries.”
Last week, 60 senators sent a similar letter to the CMS. In their communication, the senators said that flaws in quality measures led to wide variations between CMS’ quality ratings and other reports. The senators also faulted CMS for insufficient transparency on the methods and data used to determine the ratings.
The star ratings and the methods used to calculate them have long been a source of controversy. In January, the CMS issued a report that attempted to clarify the complex procedures used to determine the ratings. The report stated:
“The measures [of quality] are first selected based on their relevance and importance as determined through stakeholder and expert feedback. Next, the measures are standardized to be consistent in terms of direction and magnitude. These standardized measures are then used to construct a single hospital summary score in a two-step process. In the first step, the measures are organized into seven groups by measure type. For each group, CMS constructs a latent variable statistical model that reflects a dimension of quality represented by the measures within a given group. Each of the seven statistical models generates a hospital-specific latent variable, or group score, as a prediction of that hospital’s performance based on the available individual measures scores within a given group. CMS uses these seven group scores to organize hospitals into one of three group performance categories (above, same as, and below the national average), providing additional detail for patients and consumers for comparing across the seven groups. In the second step, a weight is applied to each group score, and all available groups are averaged to calculate the hospital summary score. Finally, to assign a Star Rating, the hospital summary score is organized into one of five categories using a clustering algorithm.”