Is CMS’s Hospital Quality Star Rating System Non-Compliant?

From: RevCycle Intelligence


The Hospital Quality Star Rating System from The Centers for Medicare and Medicaid Service (CMS) is facing scrutiny. Some industry-wide trepidation exists about whether or not CMS’s Hospital Quality Star Ratings System will result in actionable, knowledgeable decision making, as reported earlier this week.

A star rating system that forces hospitals to essentially keep patients happy by focusing more heavily on the patient experience may mean budgets detrimentally shift accordingly and quality care falls to the wayside. It is possible a hospital concerned with low star ratings may invest a heftier portion of its budget on thicker doors or softer sheets than on needed clinical advancements, as reported. Also of concern is whether or not the general public will actively consider the ratings system, as stated.

Giving Doctors Grades

From: The New York Times | OpEd


But the report cards backfired. They often penalized surgeons, like the senior surgeon at my hospital, who were aggressive about treating very sick patients and thus incurred higher mortality rates. When the statistics were publicized, some talented surgeons with higher-than-expected mortality statistics lost their operating privileges, while others, whose risk aversion had earned them lower-than-predicted rates, used the report cards to promote their services in advertisements.


Regulatory Watchdog Urges CMS To Subject Star Ratings To Rulemaking

From: Inside Health Policy

The Center for Regulatory Effectiveness tells CMS it must use regulations, which let the public comment on proposals, to establish the star rating systems that the agency increasingly uses to determine provider bonuses and rebates and to help consumers choose providers.

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CRE: CMS’ Five-Star Quality Rating System is a Violation of Medicare and APA Rulemaking Requirements

Editor’s Note: Cross-posted from OIRA Watch.

CMS’s Five-Star Quality Rating System for Part C and D Medicare is laudible concept for using informed consumer choice rather than command-and-control regulation to improve the healthcare market. However, because the Star Rating System is now used to determine bonuses, rebates, and eligibility, CMS is statutorily required to implement the ratings through Federal Register notice-and-comment rulemaking proceedings.

In the letter to CMS attached here, the Center for Regulatory Effectiveness explains the deficiencies in how the ratings were developed. CRE concludes that CMS should

  1. Follow Federal Register notice-and-comment rulemaking proceedings for the star ratings programs.

Medicare Rankings Favor Small, For-Profit Hospitals

From: The Hospitalist


The decision has not been met without controversy, particularly given the fact that just 251 hospitals out of more than 3,500 received five stars, and only two major teaching hospitals achieved the highest rating. Some professional groups, like the American Hospital Association (AHA), which issued a statement the day CMS released its ratings, believe the rankings risk “oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons.”