Study: Link between CMS hospital star ratings and socioeconomic factors

Accreditation Insider, November 29, 2016

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It’s been almost five months after CMS publicly released its hospital star ratings system amidst widespread controversy and opposition. Now, a new study by WalletHub has provided evidence that hospitals’ ratings are highly linked to their location and socioeconomic factors.

Ever since CMS announced the star system, many had argued that it was biased against facilities that treat impoverished, sicker patients. To study this, WalletHub looks at the ratings of 657 hospitals in 150 cities across the U.S. comparing ratings to each city’s “stress level,” a composite of stressor caused by work, money, family, and health and safety.

Hospitals in Detroit and Newark, N.J. (the first and ninth most stressed cities) earned an average of 1.5 and one stars respectively. However, hospitals in the California cities of Fremont and Irvine (the least and second-least stressed cities) earned an average of three and five stars, respectively. Meanwhile, CMS reports that safety net hospitals earn slightly lower ratings on average compared to non-safety net hospitals (2.88 to 3.09 stars).

 “When we look at hospital quality ratings and rankings, what we are seeing has less to do with what the hospitals themselves are doing and more to do with the communities they are located in and the patients they serve,” said David Nerenz, co-author of the study and the director of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit, to Modern Healthcare.

A hospital’s star rating is based on 64 quality measures and is meant to provide patients with more transparency on hospital quality.  The release came exactly one day after Congress proposed a bill that would have delayed its implementation for one year, required CMS to release all their data on the star ratings methodology, and have it verified by a third-party. The bill had been supported by 60 senators and more than 225 House Representatives and several different hospital groups who felt there were several major problems with the star rating methodology.

"The star ratings exist partially in a black box, incorporate measures that miss clinically relevant data, and fail to adjust for patient circumstances that influence health and healthcare outcomes—circumstances outside a hospital's control," said Bruce Siegel, MD, CEO of America's Essential Hospitals, in a statement." Consumers deserve accurate, comprehensive, and relevant information to make healthcare decisions. Hospitals deserve to be evaluated on a level playing field. The star ratings accomplish neither."


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