- Sixty U.S. senators sent a letter to CMS on Monday urging the agency to reevaluate the data analyzed in its Hospital Compare Star Ratings system, which is set for a wide release on April 21.
- Although they expressed support for reporting provider quality data, they stated the currently designed system does not accurately represent "hospitals that treat patients with low socioeconomic status or multiple complex chronic conditions."
- A study published in JAMA earlier this week found CMS' system could correspond to patient outcomes as higher star ratings were associated with lower patient mortality and readmissions.
"We are concerned that the Star Rating system may be misleading to consumers due to flaws in the measures that underpin the ratings," the letter stated.
Currently, CMS' rating system only includes hospitals with HCAHPS scores.
While hospitals may do well in other rating systems, they could be subject to harsher, and potentially wrong, judgment if CMS fails to properly account for variables like complex patients in its design, the letter argued.
Hospitals have thus reached out as they have been unable to verify whether the methodology used is accurate or fair, they added.
"We respectfully request that you delay release of the star 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," they wrote. "We urge CMS to work with Congress as well as with the hospital community affected by these star ratings to resolve these concerns," the senators wrote.
In the recently published JAMA study, researchers looked at the association between number of stars and patient 30-day mortality and readmission rates. Among the hospital characteristics they adjusted for were: Hospital size, ownership, teaching status, rurality, ICU, and hospital referral region.
Only about 4% out of the 3,076 hospitals in the sample, which was restricted to acute care hospitals with at least 25 hospitalizations, received 5 stars. Most hospitals (47%) received 3 stars.
"We found that the number of stars was inversely associated with risk-adjusted mortality rate," the study authors wrote."
Higher CMS star ratings were associated with lower mortality rates:
- 5-star hospitals: 9.8%
- 4-star hospitals: 10.4%
- 3-star hospitals: 10.5%
- 2-star hospitals: 10.7%
- 1-star hospitals: 11.2%
And with lower adjusted readmission rates:
- 5-star hospitals: 18.7%
- 4-star hospitals: 20.2
- 3-star hospitals: 21.0%
- 2-star hospitals: 21.8%
- 1-star hospitals: 22.9%.
"These findings should be encouraging for policymakers and consumers; choosing 5-star hospitals does not seem to lead to worse outcomes and in fact may be driving patients to better institutions," the authors wrote.