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Fewer CMS Stars for Hospitals in 'Stressed' Cities

News  |  By Philip Betbeze  
   December 06, 2016

The CMS star rating system for hospital quality may have more to do with community factors than hospital care quality, a report suggests.

Hospitals claim that the Center for Medicare & Medicaid Services' quality star rating system unfairly portrays hospitals in low-income communities as poor in quality. Now, a report published by the Journal of the American Medical Association appears to back them up.

The report compares a WalletHub study that attempted to quantify "stress ratings" of 150 cities, and correlates its findings with CMS's hospital star ratings of 657 hospitals in those cities. The rankings were released in late July.

Researchers say there is a strong correlation between hospitals with lower star ratings and cities labeled "high stress" on the WalletHub ranking list. WalletHub's "most-stressed cities" ranking is based on publicly available data on poverty, unemployment, the divorce rate, and adults' health conditions.

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Large teaching and disproportionate share hospitals were found to be more likely to have lower star ratings than rural and smaller hospitals.

Hospitals have protested the methodology behind the rankings ever since, saying they mask the impact on health quality of factors over which hospitals have little control, such as the level of poverty and crime in the community.

Lead researcher David Nerenz, PhD, director of the Center for Health Policy and Health Services Research at Henry Ford Health System, found that cities at extreme ends of the continuum, such as Detroit, MI and Newark, NJ (most stressed), were highly associated with lower star ratings.

Cities such as Madison, WI, and Sioux Falls, SD, at the low end of the stress rankings, had hospitals with significantly higher CMS star ratings. Henry Ford Hospital, the Detroit health system's flagship hospital, and two other Detroit hospitals received one-star ratings from CMS.

The findings suggest that the ratings depend more on the health or "stress levels" of cities as measured in the WalletHub study, and of the patients they see rather than the quality of the interventions hospitals perform on those patients, according to the JAMA research.

Nerenz, who serves on the 17-member Medicare Payment Advisory Commission (MedPAC) that advises Congress on issues affecting the Medicare program, and others have tried to convince CMS and government representatives that the rating system needs further refinement and risk adjustment.

Only 2.2% of the nation's hospitals received the highest rating of five stars.

The American Hospital Association has stated that the measurement system has "fundamental design flaws." America's Essential Hospitals called the ratings "unfortunate and counterproductive."

Philip Betbeze is the senior leadership editor at HealthLeaders.

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