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    Three top criticisms against CMS’ overall hospital star ratings


    Criticism #3: Socioeconomic bias

    The system also presents problems in terms of managing poorer populations, according to critics. Literature supports the fact that readmission rates are higher in low-income patient populations. Patients may not have pharmacies near their homes or the social support to adhere to prescribed medical regimens. But due to value-based reimbursement initiatives, hospitals that serve these patient populations may be penalized for higher readmission rates and funding may be diverted away from those hospitals to hospitals that serve patients with lower readmission rates.

    “This an absolute crime. In regard to the value-based program, we’ve taken resources from hospitals that serve the poor and taken penalties from them, and given bonuses to hospitals in better areas,” Orlowski says. “I know CMS didn’t intent to shift funds from poorer to richer hospitals, but that’s what they’ve done.”

    The AHA found similar discrepancies in how hospitals serving poorer populations were rated. “We’ve also done analysis that looks at how hospitals do by kind of a proxy or the sociodemographic status of the patient population they treat, and found that those hospitals caring for poorer patients fared worse,” Demehin says. “CMS needs to go back to the drawing board on the star ratings and comes up with a system that is fairer and more accurate.”

    What’s next?

    Prior to the launch of the ratings system, Orlowski says the AAMC urged CMS to continue working with stakeholders before making the system live to achieve better metrics and methodology. That did not happen, though, and now patients may be in a position to reject a hospital that can better serve their needs because of a faulty rating that didn’t give them a clear picture of the hospital’s worth.

    “What ended up happening is penalties and public reporting were put in right away,” Orlowski says. “The last thing you want is for people to take this information and drive by a teaching hospital because they reported more metrics and go to a hospital that reported less. This isn’t a quality, but a data issue.”

    Demehin says the star ratings should be suspended until changes can be made to avoid permanent damage to the reputations of good hospitals.

    “We really think that the system needs to be improved to ensure that it’s more accurate. We know that CMS would need to work with stakeholders to make that happen. We have argued that ratings should be suspended until we can work out a better approach,” Demehin says. “The impact of star ratings is reputational. Because these data are public, because they are shared on a Medicare website, they garner some attention.”

    In December 2016, the AHA sent a letter to then president-elect Donald Trump, outlining ideas for regulatory relief for hospitals and including proposals for suspending the star ratings until improvement can be made. There has been no answer yet, but the AHA and other associations continue to push CMS for change.

    “We have made our concerns very well known to CMS. Before the ratings were launched, we joined with AAMC and two other hospital associations to ask them to delay and consider changes,” Demehin says. “On our agenda now is really taking a look at the regulations that affect hospitals and trying to identify those we think need to be changed and improve to better align with patient care and create more efficiency.”

    When pressed by Managed Healthcare Executive about the criticisms of the ratings system, CMS officials say “substantial efforts” were made to involve stakeholders and hospitals in the development of the system, citing a July 2015 dry run of the system as well as numerous meetings and calls throughout 2016.

    “CMS is committed to improving outcomes and working with stakeholders to improve individual quality measures, while minimizing unintended consequences for all facilities, regardless of the characteristics of the patients they serve,” the agency wrote in a statement to Managed Healthcare Executive. “We anticipate that a new (technical expert panel) will be empaneled by our contractors in early 2017 to discuss possible updates to the methodology. We look forward to continued discussions with stakeholders in late Spring/early Summer 2017.”


    Rachael Zimlich is a writer in Columbia Station, Ohio.

    Rachael Zimlich, RN
    Ms Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and ...


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