5-Star Ratings Don’t Mean 5-Star Care

Despite aggressive criticism, CMS is proceeding to release its star ratings for hospitals this month. Hospital advocates have been among the most vocal opponents, citing two primary concerns:

  1. The ratings vastly oversimplify a complex set of metrics.
  2. There are no concessions for social determinants of illness.

Ashish Jha, MD, a professor at Harvard’s T.H. Chan School of Public Health, has advocated against the ratings, predominantly for the two reasons stated above. Rick Pollack, president and CEO of the American Hospital Association, expressed similar reservations:

“As currently designed, CMS’ star hospital ratings program is not up to the task of providing the public with meaningful and accurate assessments of hospital performance. Patients need reliable information to make important choices regarding their healthcare. And hospitals and health systems need reliable information so that they can continue to improve the quality of the care delivered. CMS star ratings misses the mark on both accounts.”

In spite of such criticisms, the program does have some advocates, including the AARP, which contends that patients deserve transparency and simplicity to help them make rational decisions about where to seek their healthcare.

As a Chief Quality Officer at a large academic medical center, I wholly agree with transparency and simplicity, but patient complexity and socioeconomic status cannot be ignored. It is already well-known that large, teaching and safety net hospitals are being financially penalized in the current CMS pay-for-performance programs, which have also foraged on despite criticism on lack of adjustments for patient complexity and socioeconomic status.

My hospital, along with many others, will be penalized and branded as low quality. This is misleading for my patients and demoralizing and deflating for my providers and my community – all of whom are invested in compassionately caring for “all comers” at the highest level of quality.

For hospitalists, we should continue to compassionately care for patients for all the right reasons, and not be dispirited by rankings that do not take into consideration patient complexity.

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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