CMS Plans 2021 'Update' for Hospital Quality Star Ratings

Policymakers are sifting through more than 800 public comments on proposed changes to the Hospital Compare methodology.

The Centers for Medicare & Medicaid Services said Monday it will update its controversial Overall Hospital Quality Star Ratings in 2021.

Until then, CMS said it will "refresh" the Star Ratings, which appear on the Hospital Compare website, in early 2020 using the existing methodology while a new methodology is being finalized for 2021.

Although the methodology had typically been updated every six months, the ratings have been updated only once since 2017 amid long-running complaints over their accuracy.

CMS this week posted a summary of the more than 800 comments received on potential changes to the ratings during a public comment period that ended March 29.  

CMS said in a media release that "only a few comments recommended removing or suspending the Overall Star Ratings from Hospital Compare until changes are made."

"The comments are largely consistent with previous stakeholder feedback, with the most common concerns about the Overall Star Ratings being that CMS should improve its usefulness for consumer decision-making and hospital improvement," CMS said.

Since the five-star ratings inception in 2016, hospital stakeholders have repeatedly called on CMS to delay, revise or eliminate them until policymakers could address hospitals' concerns about the accuracy and correct use of the data.

CMS provided no details on what the changes to the star rating could encompass for 2021. However, the agency acknowledged that stakeholders have continued to raise concerns that the ratings are too complex, or oversimplified, imprecise, and provided without proper context for "more direct 'apples-to-apples' comparisons."

The American Hospital Association has a long history of criticizing the methodology, calling it confusing, complex, inaccurate and basically useless for most consumers.

AHA Senior Vice President of Policy Ashley Thompson said Monday the association was "disappointed that CMS intends to continue using a hospital star ratings approach plagued by longstanding concerns about its accuracy and meaningfulness."

"While we appreciate that CMS is working on potential improvements to the rating methodology, we strongly believe CMS should not refresh the ratings until those improvements have been vetted and are ready for implementation," Thompson said.

"Republishing the flawed ratings in 2020 will not advance the goal of providing the public with accurate, purposeful information about quality."

Bruce Siegel, MD, MPH, president and CEO of America's Essential Hospitals, said the safety net hospitals' association appreciates CMS' "efforts to engage stakeholders" in the rulemaking process.

"However, in the meantime, the agency's plan to refresh data using a methodology that is under review for its shortcomings is misleading to patients," Siegel said.

"The star ratings continue to reflect a flawed methodology rather than actual hospital performance and improvement. In particular, these ratings fail to account for social risk factors beyond a hospital’s control that affect performance."

Siegel said safety net hospitals support providing patients with "relevant information."

"But the current star ratings are not the way to do this. We urge the agency to suspend the ratings until methodology updates are complete," he said.

CMS said it is planning additional public outreach to shape potential changes to the Overall Star Ratings methodology, including a public listening session in Baltimore on September 19 that will include a call-in option.