Hospitals Concerned About CMS “Star Ratings”

CMS has added a star-rating system on its Hospital Compare website to help Medicare beneficiaries’ choose a hospital and gauge the quality of the care it provides.


A recently released CMS fact sheet described the initiative: “CMS believes that star ratings spotlight excellence in health care quality and make it easier for consumers to use the information on the Compare websites . . . consistent with the call for transparent, easily understood and widely available public reporting found in the Affordable Care Act. The ratings also support using quality measures as a key driver of health care system improvement.” (“Hospital Compare Star Ratings Fact Sheet,”, April 16, 2015)


Star ratings result from the HCAHPS survey completed by patients at nearly 3,500 Medicare-certified acute care hospitals.  The 12 star ratings for each hospital represent results for each of 11 publicly reported HCAHPS measures and an overall rating.


These ratings will be updated each quarter, according to the CMS fact sheet. The April 2014 ratings are based on patients discharged between July 1, 2013 and June 30, 2014.


The topics tracked under the ratings include:

  • How well nurses and doctors communicated with patients
  • How responsive hospital staff were to patient needs
  • Pain management
  • How clean and quiet the hospital environment was
  • How well-prepared patients were for post-hospital settings


Star ratings already are used for nursing homes, physician group practices and dialysis facilities, and are planned for Home Health Compare later this year. Eventually, Medicare plans to expand the star ratings to include other areas, such as clinical outcomes and safety, according to published reports. (“Star Ratings Added for Hospitals,” HFMA Weekly News, April 24, 2015)


Providers and policy experts have expressed concerns, warning that HCAHPS is a subjective instrument that tends to disproportionately penalize hospitals. For example:


  • Past HCAHPS analyses: cultural impacts—Northeasterners being more likely than Midwesterners and Southerners to express dissatisfaction
  • 2014 review of Hospital Compare: hospitals in South Dakota, Nebraska, Louisiana and Iowa fared best in hospital patient reviews
  • Advisory Board analysis: among the top-scoring hospitals, more than four out of five were specialty facilities—surgical hospitals, orthopedics hospitals, or heart hospitals that treat very few less predictable, more difficult-to-manage cases
  • 2013 study: patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture
  • 2013 survey: 88 percent of patients with highly positive billing experiences would recommend the hospital (one of the HCAHPS measures)


HFMA has urged CMS to “conduct a patient-level study to better understand the relationship between HCAHPS scores and outcomes, including the effect of factors beyond a hospital’s control, such as patient severity and region,” to avoid the risk of inappropriately penalizing facilities for a measure that may have little relationship to patient outcomes. (“Star Ratings Added for Hospitals,” HFMA Weekly News, April 24, 2015)



Special Note: The Department of Health and Human Services Office of the Inspector General has just released “Practical Guidance for Health Care Governing Boards on Compliance Oversight,” a publication that focuses on regulatory risks and compliance programs. The publication’s conclusion appears here:


“A health care governing Board should make efforts to increase its knowledge of relevant and emerging regulatory risks, the role and functioning of the organization’s compliance program in the face of those risks, and the flow and elevation of reporting of potential issues and problems to senior management. A Board should also encourage a level of compliance accountability across the organization. A Board may find that not every measure addressed in this document is appropriate for its organization, but every Board is responsible for ensuring that its organization complies with relevant Federal, State, and local laws. The recommendations presented in this document are intended to assist Boards with the performance of those activities that are key to their compliance program oversight responsibilities. Ultimately, compliance efforts are necessary to protect patients and public funds, but the form and manner of such efforts will always be dependent on the organization’s individual situation.”


For a link to the OIG report, please contact Carlin Lockee,






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