Critics of Medicare’s Overall Hospital Star Rating Push for Changes

On July 27, 2016, the federal government released its new hospital star rating system. Despite concern from the hospital industry and health care providers about the validity of the formula, ratings were released for more than 3,600 hospitals across the country.

With many well-known hospitals throughout the United States receiving average or below average scores, the rating system has certainly fueled debate throughout the health care industry. Learn more about how critics of Medicare’s overall hospital star rating are pushing for changes.

Medicare’s Hospital Star Rating

Medicare’s goal in creating the star system was to help consumers make an informed choice about the hospitals they choose. In a presentation made to hospitals in May, Medicare officials said that “the overall star rating represents a performance summary designed to facilitate patient and consumer use of Hospital Compare,” adding that the scores will be updated fairly regularly. Andrew Scholnick, a lobbyist for AARP, told Kaiser Health News (KHN) that “the star ratings hopefully will get quality into [the] decision-making process.”

KHN correspondent Jordan Rau points out that “Medicare’s move toward using star ratings is part of a greater focus on easy-to-grasp composite judgments of hospital quality,” and that the agency hopes that “a star rating from the government will carry even more credibility.”

Many advocacy groups like the National Partnership for Women & Families are happy with the results. Debra Ness, the nonprofit group’s president told Rau that “consumers can use this trustworthy program to compare hospitals side by side… this is a huge step forward.”

However, critics of the rating system question whether the formula for rating hospitals across the country is actually providing patients with a valid picture of the level of patient care being offered.

“Dr. Elizabeth Mort, chief quality officer at Massachusetts General Hospital in Boston — which Medicare awarded four stars — said Medicare should have factored in attributes of each hospital, such as what kind of services it offered and how the nursing profession assesses the staff quality,” Rau reports.

Overall, critics agree that the hospital rating system is lacking and express particular concern around low scores in these areas:

1. Low Scores for Teaching Hospitals

Out of 288 teaching hospitals, six in 10 received below-average scores and a sizable proportion of the nation’s major academic medical centers, which train doctors, scored poorly. In fact, one-third of the hospitals that received one-star were teaching hospitals.

2. Low Scores for Hospitals with Cancer Centers and Those Treating Complex Illnesses

The rating system seems to favour smaller hospitals located in affluent areas that don’t have the facilities needed to take on complicated cases. “They don’t have comprehensive cancer centers, they don’t have major cardiovascular disease, they don’t have neuro-specialties,” Steven Lipstein says of the hospitals in his organization that received five stars. Lipstein is president of BJC HealthCare, a St. Louis-based nonprofit organization that runs 14 hospitals.

3. Low Scores for Hospitals Treating Low-Income Patients or Situated in Low-Income Areas

Socio-economic factors are also skewing the rating system’s results. “Facilities with more low-income patients, who often face difficulties affording medication, following complicated recovery instructions and getting to doctors regularly, typically have higher readmission rates,” which skews their rating, Rau explains.

Despite the criticism, “Dr. Kate Goodrich, who oversees Medicare’s quality ratings, said in a statement that it has been using the same type of rating system for other medical facilities, such as nursing homes and dialysis centers, and found them useful to consumers and patients,” Rau reports. According to Goodrich, these ratings have shown, “that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries.”

With dust still settling after the introduction of the rating system, time will tell whether rating hospitals through this system actually adds value to consumers, patients, Medicare beneficiaries and the health industry as a whole.

Are these types of rating systems useful to consumers and patients, or confusing and problematic? Share your thoughts with us in the comments below.

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