The Federal Financial Forum

From: The New York Times | OpEd

Sandeep Jauhar

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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.

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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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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.

From: The Hospitalist

Kelly April Tyrrell

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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.”

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From: LegalNurse.com

Suzanne Arragg

With changes in the Five-Star Quality Rating System affecting the nursing home industry, the Certified Legal Nurse Consultant must understand how Centers for Medicare & Medicaid Services (CMS) collects and relies on data from various data sources.

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So what does all this mean? Based on an evaluation of the Five-Star Quality Rating System by Abt Associates, between 2009 and 2013 the percentages of facilities receiving a five-star rating more than tripled and the percentage of facilities receiving one star declined. This finding was attributed to the facilities’ “considerable gaming on the rating system.” [Emphasis added]