Topic: Hospital ratings are deeply flawed. Can they be fixed?

The US Centers for Medicare and Medicaid Services (CMS) regularly releases star-system ratings for US hospitals, and did so in January 2020, on the cusp of the COVID-19 outbreak. The news about ratings did not make a lot of headlines, and was quickly buried by stories about the public-health crisis.

But the release of the ratings was an important moment for patients looking up which facilities might provide the best care for nonemergency procedures—and for the health-care industry, which has billions of dollars at stake. The pandemic has slashed hospital revenues, and hospitals with high ratings may advertise those heavily to attract non-COVID-19 patients and the dollars they bring with them. Ratings can guide patients’ decisions, shape negotiations between hospitals and insurance companies, and determine how much health-care providers get reimbursed by both the federal government and insurers.

Of the four major hospital rating systems available to patients in the US, the CMS offers perhaps the most influential one. As the health-care industry fights COVID-19 on multiple fronts, it’s worth taking a deep dive into the CMS’s ratings to understand how they affect the success or failure of a hospital. Academic researchers have scrutinized the methodology to identify flaws in the CMS system, and to come up with ideas for modifying the ratings. Their research holds the promise of producing more-accurate measurements that could better inform the decisions of patients, hospitals, insurance companies, and the federal government—and of ultimately improving the hospital system, and public health more generally.

The Star System

Whether they’re looking to get a meal at a local restaurant or buy a blender on Amazon, modern shoppers are often guided by the advice of professionals or other customers. When it comes to seeking medical care, the impulse is no different. According to a 2018 Deloitte survey, 39 percent of respondents considered reputation when choosing a doctor, and nearly one-quarter said they had used a quality rating when choosing a doctor or hospital, up 5 percentage points from a 2013 survey. More than half of respondents said they planned to use such ratings in the future.

The CMS rates a hospital’s quality of care using 51 measures centered around common, serious issues—such as heart failure and pneumonia—among Medicare patients who require hospitalization. It launched a star rating system in 2016 to provide more information about a hospital, including patient experience, complications and deaths, and value of care. Its online patient-focused Hospital Compare tool allows people to compare hospitals on the basis of their overall star ratings.

Topic Discussed: Hospital ratings are deeply flawed. Can they be fixed?

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