How to Look at the Star Rating System

September 29, 2016 Merrie Wallace

Imagine one day, your brother was a transplant patient preparing for surgery. But a few short days, one missed diagnosis and two failed transplants later, he rejected his new liver and died in the intensive care unit.

While this particular example is a true story that I witnessed during my early days as a nurse and transplant coordinator, anyone who has provided care has a similar story. Sometimes on the patient care journey there is a breakdown, whether it be with information, process, supply, clinical or a combination, and a lack of quality results in loss of life.

The quality of care has an impact on everyone involved—from patients and providers to our communities and the economy. At the end of the day, consumers want information that helps them make smart choices when deciding where to go for the highest quality care.

With this in mind, earlier this summer the Centers for Medicare & Medicaid Services (CMS) established a hospital quality star rating system. These ratings are a composite metric of one to five stars, with five stars being the best. This measure was taken to convey overall quality of nearly 4,000 hospitals in the United States.

Created to provide patients and their families a way to compare hospitals and make informed choices, CMS chose 64 measures, such as hospital-acquired infection rates and emergency room wait times, and then grouped these measures into broader categories. Quality, cost, patient experience and outcomes are all reflected in star rating scores. The idea is that consistency and level of quality will manifest in a hospital’s score over time.

However, there are questions with the current system that CMS has in place. While public data puts some control back into the hands of patients, there are concerns around the validity and limitations of the methodology, the age of the data and how the system competes with overlapping quality and payment programs. For example, the ratings do not account for social risk factors, which can result in underestimating the quality of care provided by physicians serving vulnerable populations.

As of July 2016, just 102 of 4,599 hospitals (or 2.2%) earned five stars. Although Congress recently introduced legislation to remove the current posting and other industry organizations have joined the chorus, this left many industry professionals asking: what can hospitals do to improve these scores? Even with its flaws, the transparent nature of the star ratings system can affect a hospital’s overall brand.

While industry stakeholders, including Premier, advocate for changes to the system to better recognize provider excellence, hospitals cannot afford to wait.

Premier has been cultivating improved performance for many years. Our QUEST® performance improvement collaborative was launched eight years ago to define and cultivate top performing hospitals, leveraging shared quality and performance metrics. Since then, approximately 350 hospitals have saved thousands of lives and billions of dollars, reduced readmission rates and outperformed their non-QUEST peers in mortality. Looking at the new 5-star hospital rating system, QUEST members scored 21 percent higher than comparable non-QUEST facilities.

Learn more about driving quality improvement in healthcare.

Author information

Merrie Wallace

Merrie Wallace

I’m a quality improvement expert from Atlanta, Georgia, who travels the nation working with health systems to improve their quality and PI initiatives. When I’m not working, you’ll find me boating or watching UGA football games. Connect with me on LinkedIn.


The post How to Look at the Star Rating System appeared first on Action For Better Healthcare.

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