3 Reasons CMS Star Ratings Are Misleading

Philip Betbeze, January 12, 2017
Howard Kern
Howard Kern

CR rates everything from washing machines to new cars by compiling a weighted overall rating that also shows critical subcategory ratings and allows the consumer to scan overall quality. This allows consumers to pinpoint the items that are important to them.

"A mother looking for a place to have her baby is looking for different things than someone who's having a hip replacement," Kern says.

"For most community hospitals and big academics, breaking out data from the overall score by service line or by category of clinical quality, safety, and customer experience, gives them a look on that level so they can weigh for themselves what's important to them."

Another factor: the data CMS relies upon for the ratings comes only from Medicare patients.

"There are not too many mothers having babies through Medicare," Kern quips.

"CMS may not have the ability to drag data from other payers—they may need legislative action for that—but other states have done it, most notably in Pennsylvania with heart surgeries."

2. Size Shouldn't Matter

Some 87.5% of hospitals that earned five stars under CMS's ratings scheme have fewer than 100 beds, says Quantros' Mazza. Some are critical access hospitals, which by definition have less than 25 beds, and 68% of five-star hospitals don't have an ICU, he says.

Rural Hospital Tracks Shift to Value in CMS Star Ratings

"Anyone who has clinical knowledge knows that when people are very sick with pneumonia, for example, they wind up in the ICU with special medicines," Mazza says.

Heart attack patients will be in the ICU with lines and drips, while congestive heart failure patients may be on artificial hearts.

"These are not things that are offered in very small critical access hospitals—they're offered in big medical centers with sophisticated capabilities," he says.

"We have a lot of critical access hospitals here in Texas. Many are wonderful places with wonderful people who do the best they can, but it is hard to believe they offer the highest quality of care with these three conditions."

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.

Facebook icon
LinkedIn icon
Twitter icon