- U.S. cities with higher stress factors tend to have hospitals with lower CMS star ratings than less stressed cities, according to a new JAMA study.
- Researchers at Henry Ford Health System's Center for Health Policy & Health Services Research compared CMS' recent ratings from its Hospital Compare website to recently released stress rankings of 150 U.S. cities to explore associations and community characteristics as predictors of hospital quality.
- The results back up previous observations that large, teaching, and disproportionate-share hospitals are likelier to have lower star ratings, the researchers said.
Concerns have long been held around the facts that teaching hospitals and safety-net hospitals tend to have lower ratings, and arguments that the design of the star rating system are weighted unfairly against those hospitals that serve lower-income patients and those that require more complicated procedures. CMS actually postponed its ratings’ release this year from April to July under pressure from 225 House members and 60 senators.
The findings not only point toward a need for further research on the associations between community stress factors and the healthcare available in those communities, as noted by the authors, but also add context in which to consider CMS' hospital star ratings.
City stress rankings were determined using 27 metrics such as divorce rates, credit scores, and suicide rates. In Detroit, Mich., ranked the most-stressed city, the average hospital rating is under two stars, whereas in Madison, Wis., ranked one of the least-stressed cities, the average is almost five stars.
"On one hand, hospitals in stressed cities might provide care of lower quality on average, perhaps because of inability to invest in needed clinical or technological infrastructure or staff shortages," the authors wrote. "On the other hand, the star rating component measures may be affected by community factors such as poor transportation or limited social support services through causal pathways other than hospital quality."