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Changes to CMS Hospital Ratings

By  Senior Market Advisors  on December 17, 2018

Changes to CMS Hospital Ratings

When making medical related decisions, it’s common to do your research. These decisions directly impact your health and well-being. Many patients are interested in comparing statistics when choosing doctors or hospitals. CMS hospital ratings and the Hospital Compare website are two tools that are available to consumers.

What are the CMS hospital ratings?

CMS uses star ratings to calculate how hospitals perform in seven categories. These categories include mortality, safety-of-care, readmissions, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging. Readmissions, safety-of-care, and mortality are the three most heavily weighted groups. These three groups account for 22% each towards the total rating. CMS hospital ratings can be found on the Hospital Compare website.

What is Hospital Compare?

Hospital Compare is a consumer-facing website through CMS that provides information that allows the consumer to compare various hospital information in their area. This information includes statistics on complications, readmissions, deaths, payment, and more.

Delay for CMS Hospital Ratings

The new CMS hospital ratings have been delayed for 14 months but will be updated to Hospital Compare in February. The delay stemmed from an issue in the July preview where the ratings showed 98% of the safety-of-care domain relied on hospitals’ complication rates from hip and knee replacements. This means that hospitals were seeing drastic changes to their overall rating, which is uncommon year to year.

Changes to Methodology

CMS has used a latent variable model for assigning hospital ratings in the past and continued this trend for 2019.  The latent variable model assigns coefficients that calculate how much that part of the equation will weight in the overall rating. This statistical approach emphasizes certain measures based on how they correlate. CMS does not choose which measures to emphasize, instead, the model chooses.

CMS supports the latent variable model because it accommodates for changes over time. However, CMS did make two changes to the methodology. First, they removed any measures with statistically significant negative loadings. Secondly, they changed how the healthcare-associated infections measure the safety-of-care group is weighted.

Current Issues

While CMS did make changes to respond to issues within their methodology, critics still worry about hip and knee replacements generating negative impacts on a hospital’s rating. Plus, another issue that has been raised is the role of dual-eligibles in hospitals. Many hospitals with a high percentage of dual-eligibles have lower readmissions scores, which hurts their overall star rating. Instead, critics would like to see risk-adjustment included when calculating the scores, or at minimum, implement some form of socio-economic adjustment.

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