CMS is proposing several changes to its controversial hospital star ratings program that lobby groups and health policy experts hope can help fix some major flaws.
The program, long blasted by providers as arbitrary and burdensome, gives one to five stars for hospitals based on self-reported quality metrics.
CMS has maintained that it is essential to give patients information about hospital performance in an easy to access and understandable format, but has been open to tweaking the formulas in response to criticism. Hospitals have sought unsuccessfully to have to have rankings scraped altogether.
One major proposal to the Hospital Compare website, included within the agency's 2021 outpatient payment rule, would group peer hospitals, a move CMS star ratings critics, including providers, have sought.
Peer grouping entails putting hospitals that report the same number of measures in the same group. Effectively using a more apples-to-apples comparison of facilities of the same size instead of a broad overview.
Measures CMS uses to gauge hospital quality include mortality, readmission and patient experience, among many other metrics within those measure groups, which some smaller or specialty hospitals are unable to report.
That could help with the comparability of ratings among hospitals, Karl Bilimoria, a Northwestern professor and member of a technical expert panel CMS commissioned before proposing the changes, said. CMS currently groups all hospitals together irrespective of what type of hospital and how many measures they report, he noted.
"By comparing it based on the number of measures they submit, we'll get closer to comparing like hospitals," Bilimoria said.
CMS uses seven measure groups — mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care and efficient use of medical imaging.
It wants to merge three of those groups — effectiveness of care, timeliness of care and efficient use of medical imaging — into one measure group, called timely and effective care.
For hospitals to receive a star rating, they must report at least three measures for three measure groups, though one must be in mortality or safety of care. CMS said by merging three groups into one, more hospitals will be able to meet the threshold, especially community access hospitals.
Many of these CAHs are in remote areas with limited patient choices when seeking care, CMS noted.
It warned, however, that the peer grouping proposal is dependent on participation from community access hospitals, which voluntarily submit and will continue doing so — though some will likely still fall short of the minimum reporting threshold to receive a rating.
"CAHs make up approximately half of the hospitals with three measure peer groups and excluding CAHs from the Overall Star Ratings would not provide a sufficient amount of hospitals to make peer group comparisons," the agency said.
Another change CMS wants to make is reporting rankings annually rather than quarterly. It said publishing a hospitals' ratings once a year would allow more time for it to better reflect improvements or updates in its performance.
It also wants to calculate group measure scores using a simple average. That means tossing the latent variable model used in the past, a confusing statistical model used to create a composite score for each group.
Bilimoria is optimistic about the adjustments and thinks they'll produce a better look at the actual quality of hospitals as originally intended — though no system is perfect.
In 2019 he co-authored a paper grading the hospital rankings systems themselves using metrics like usability and potential for misclassification.
It's not an empty field — Leapfrog and U.S. News and World Report are other well-known hospital rankers, though they sometimes offer conflicting results.
The paper gave the CMS model a C grade overall, slightly above Leapfrog's C-, though U.S. News and World Report's scored the highest with a B grade.
The American Hospital Association said it's encouraged by the significant methodology changes CMS is considering, "given the substantial problems with CMS’s current approach to hospital star ratings," though it's continuing to review the proposals in depth. America's Essential Hospitals said it's also pleased and looks forward to additional improvements.
CMS is seeking feedback on the proposed changes. Comments are due by Oct. 5 and, if finalized, take effect Jan. 1.