Hospital Star Ratings Show Patients, Providers That Not All Care Is Equal

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It’s not as user-friendly as Consumer Reports, but the Centers for Medicare & Medicaid Services’ overall star rating system represents progress in getting data into the hands of health care consumers. And despite some methodological shortcomings, it puts providers on their toes, which is a good thing.

On July 27, CMS published one-to-five-star ratings of the overall quality of hospitals, designed to help patients and their loved ones compare facilities near them side-by-side.

The ratings are intended to empower consumers in asking important questions about their care, the process it’s likely to follow, the costs and outcomes they can expect (including risks), and what their other options may be when they anticipate being admitted to a hospital.

The ratings summarize 64 quality metrics into a single score, covering everything from patient satisfaction to safety issues like hospital-acquired infections and mortality rates – and lots in between.

Critics have blasted CMS for trying to boil down a broad range of nuanced measures into what many believe is an oversimplified rating. While this criticism and others have merit, it’s important to recognize that the ratings will evolve over time, and still have value even if they’re far from perfect.

The scores raise awareness that, quite simply, not all hospitals deliver the same level of quality. That’s especially important to recognize in light of recent research by Dr. Marty Makary and his colleagues at Johns Hopkins University Medical School that identified medical errors as the third-leading cause of death in the U.S., behind only heart disease and cancer.

Transparency has driven improvements in many industries, and it’s apparent to most people that in health care, too, reducing costs and improving quality requires a public view into performance. It’s only more critical if we want to make the future of health care market-driven and consumer-centric. With higher copays and deductibles, patients increasingly have more “skin in the game,” but they have little of the quality information needed to inform decisions about where to go for care.

For the nearly one in five hospitals that earned just one or two stars, the rating should serve as a wakeup call to be heard all the way from the nurses’ stations to the chief executive’s and other administrative officers’ suites. Once the initial sense of dismay, anger, frustration and/or failure abates, the score should serve as a call to action, to get everyone onboard. It will take the entire organization rowing in unison to make fundamental changes and improve the rating, which is updated quarterly.

Blaming the rating system (despite its flaws), or denying or rationalizing a low score serves no useful purpose. Providers must do a serious analysis of the data to understand how the ratings came to be and what needs to change in their organizations. There has to be accountability for building a culture of excellence and achieving “zero defects.”

As for the 102 hospitals that received a five-star rating, they should resist the temptation to rest on their laurels. For one thing, the ratings aren’t based on current data, so hospital leadership must ascertain whether their organizations are continuing to deliver that high-level performance — and then strive to improve upon it. 

As the country’s largest payer, CMS is taking bolder steps to connect the payments it makes to actual health outcomes and establish the transparency and accountability that consumers need to make informed decisions. While we’re still a long way away from the market-based health care system we genuinely need, the overall star ratings force critically needed discussions about quality, cost, and outcomes.

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