- Social risk factors may impact the quality scores that hospitals in vulnerable communities earn in CMS' Hospital Compare star rating system, a study in the journal Medical Care suggests.
- Researchers at University of Chicago Medicine found associations between some quality scores used in the ratings program and neighborhood-level social risk factors such as the percentage of residents who are unemployed or do not have a high school degree.
- The quality score most strongly associated with social risk factors was timeliness of care — a measure hospitals have minimal control over because it reflects how abundant (or not) medical services are in a community.
CMS collects the data for its Hospital Quality Initiative programs on a variety of metrics including patient experience, patient safety and readmission and mortality rates. The agency uses that information to rank more than 4,000 Medicare-certified, Veteran's Health Administration and military hospitals and publishes the rankings on its Hospital Compare website.
But providers have disputed the methodology CMS uses to compile its star ratings for years, saying the agency's approach to measuring quality is overly simplistic and the presentation of data to consumers is difficult to interpret.
In a study in Health Affairs last year, for example, researchers divided hospitals into three peer groups based on the total number, volume and variety of quality measures they report on. They demonstrated how groups with more extensive reporting requirements tended to earn lower ratings than those that reported on fewer measures.
In the latest study, researchers analyzed the impact of social risk factors on seven categories of quality scores that CMS uses to compile its ratings: effectiveness of care, efficiency of care, mortality, patient experience, safety of care, timelessness of care and hospital readmission. A total of 3,608 hospitals were included in the report.
Some of the risk factors analyzed were travel times to work, dual eligibility for Medicare and Medicaid, languages spoken other than English and median home values.
The association between social risk factors and hospitals' quality scores was most pronounced for timeliness of care, hospital readmission and patient experience.
However, there was virtually no association between social risk factors and scores for patient safety, efficiency and effectiveness of patient care — measures hospitals control directly because they involve medical care provided inside their walls.
"Our study suggests that a hospital's quality rating may be tied to its geographic location — its place," the researchers wrote. "Hospitals caring for neighborhoods with high levels of disadvantage may have lower hospital ratings, not because of the quality of care provided within hospital settings, but because of (social risk factors) experienced in neighborhood settings."
Despite the criticisms from providers, CMS released a new version of its star rating system last spring, after delaying updates for more than a year.
CMS also released for public comment proposed changes to how it calculates star ratings, such as comparing hospitals against other facilities in a peer group rather than against all hospitals.