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Medicare Advantage Program Standards Tightening

Christopher Cheney, for HealthLeaders Media, April 7, 2014

Big Ratings Star Ratings Changes to Come in 2016
In seeking a better way to finesse the "minute differences" in quality assessment grading, CMS is poised to make a controversial change to the MA star ratings program, Kavouras says.

The 2015 rules could include the removal of a suite of set standards used to help determine four-star quality ratings. The current set standards include quality measures such as the percentage of a MA health plan's beneficiaries who get annual breast cancer screening.

"A key concern is the potential for generating Star Ratings that do not reflect a contract's 'true' performance, otherwise referred to as the risk of 'misclassifying' a contract's performance (e.g., scoring a 'true' four-star contract as a three-star contract, or vice versa)," CMS states in the proposed 2015 rules.

"Misclassification," it reads, "occurs in any measurement system because all performance measurement is a mixture of signal (true performance) and noise (random measurement error due to rounding, variation due to who is sampled, and similar factors)."

The proposed 2016 star measurement change is designed to strike a better balance between transparency for consumers and the wealth of data at regulators' disposal to set star ratings, according to the proposed rules:

"Over the years several features have been implemented in the quality rating system to simplify the information for consumers, as well as to make the ratings process and methodology more transparent for organization/sponsors. For example, we group the measure scores into star categories and round the data to make it easier for consumers to understand what a particular score means."

"We have also implemented pre-determined four-star thresholds for some measures since the 2011 Star Ratings to increase transparency for organizations/sponsors and set a priori expectations for high performance. However, all of these features create more 'noise' or measurement error in the system."

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