/ en Fri, 25 Apr 2025 14:48:53 -0500 Wed, 31 Jul 24 17:02:45 -0500 /news/headline/2024-07-31-cms-updates-annual-overall-hospital-quality-star-ratings <p>The Centers for Medicare & Medicaid Services July 31 updated the <a href="https://www.medicare.gov/care-compare/">Overall Hospital Quality Star Ratings at its Care Compare</a> website and <a href="https://data.cms.gov/provider-data/">Provider Data Catalog</a>. CMS assigns the ratings annually and are based on safety of care, readmission rates, patient experience, timeliness of care and mortality rates. <br><br>"As expected, this year’s CMS Hospital Overall Star Ratings distribution looks largely like 2023 given that the methodology that hospitals are rated on has remained stable for the last few years," said Akin Demehin, AHA senior director of quality and patient safety. "Multiple factors could contribute to a hospital experiencing a shift in ratings, including changes to underlying measures used to calculate the ratings, the time periods used to calculate performance and minor coding changes. This year’s ratings also continue to include data reflecting the profound effect the COVID-19 pandemic had on hospital operations.  <br> <br>"As with any ranking or rating methodology, star ratings reflect only available measures, and as a result, the relevance of the rating to a particular patient’s care needs could vary. That is why the AHA continues to encourage patients to complement information from star ratings and other hospital rankings with discussions with clinicians who know their care needs to help make fully informed decision about their care. Lastly, while AHA appreciates CMS’s work in recent years to make the ratings more transparent and easier to interpret, we have continued to encourage CMS to make <a href="/news/blog/2022-07-14-blog-understanding-cms-changes-hospital-overall-star-ratings">improvements</a> to the methodology to ensure hospital performance is portrayed accurately and fairly."</p> Wed, 31 Jul 2024 17:02:45 -0500 Star Ratings /guidesreports/2023-08-03-new-analysis-validates-need-preserve-restrictions-growth-physician-owned-hospitals <div class="container"> <div class="row"> <div class="col-md-8"> <p><strong><span>As some members of Congress continue to propose weakening Medicare’s prohibition on physician self-referral to new </span><a href="/fact-sheets/2023-02-27-fact-sheet-physician-self-referral-physician-owned-hospitals" target="_blank">physician-owned hospitals (POHs)</a><span> and loosening restrictions on the growth of existing POHs, new data from </span><a href="/guidesreports/2023-08-03-analysis-selected-medicare-quality-measure-reporting-data-hospital-ownership">Dobson | DaVanzo</a><span> show that POHs report fewer quality measures and perform worse on readmission penalties compared to full-service community hospitals.</span></strong> Hospital Star Ratings are reported on the Centers for Medicare & Medicaid Services’ (CMS) Care Compare website, and these ratings allow the public to compare hospitals’ performance based on standardized quality metrics.</p> <p>This new analysis reinforces <strong><a href="/news/blog/2023-04-24-physician-owned-hospitals-are-bad-patients-and-communities">previous findings</a></strong> that POHs generally treat a population that is younger, less complex or comorbid, and less likely to be dually eligible for Medicare and Medicaid. Despite treating a healthier and better insured population than similarly situated community hospitals, POHs received higher readmission penalties from CMS. This new study found that:</p> <ul> <li><span><strong>POHs generally report fewer quality measures within each measure domain of Medicare’s Hospital Star Ratings compared to general full-service acute care hospitals.</strong></span> On average, POHs reported fewer measures compared to general acute care hospitals for patient safety (2.8 vs. 5.0 measures), readmissions (4.3 vs. 7.7 measures), and timely and effective care (2.9 vs. 6.4 measures). The fact that POHs report on fewer quality measures demonstrates that they are fundamentally different from full-service community hospitals – they treat fewer patients (and therefore may not reach thresholds for reporting), provide fewer services and do not meet as wide a range of patient clinical needs.</li> <li><span><strong>POHs are more likely to be in the lowest peer group for Hospital Readmissions Reduction Program (HRRP) reporting and perform worse than other hospitals within their own peer group.</strong></span> Peer groups in the HRRP are defined based on the proportion of a hospital’s care that is provided to patients who are dual-eligible for Medicare and Medicaid. Specifically, 78% of POHs were in the lowest dual-eligible peer group for HRRP reporting compared to 19% of general acute care facilities. This finding validates prior research showing that POHs treat far fewer dual-eligible patients than general acute care hospitals.</li> <li><span><strong>POHs performed worse than full-service community hospitals on readmission metrics as part of the HRRP, which reduces Medicare payments to hospitals with excess readmissions.</strong></span> Even though POHs treat younger, less medically complex patients with fewer comorbidities, the report shows that POHs had higher average penalties (0.4% payment reduction vs. 0.3% payment reduction), and a much higher percentage of POHs received the maximum payment penalty compared to general acute care hospitals in the same lowest dual-eligible peer group and market (6.7% vs. 0.5%). At least eight POHs in the lowest peer group received the maximum readmission penalty, which is notable considering only 17 total hospitals (both POH and non-POH) across all five peer groups received the maximum penalty in 2023 and only 10 total hospitals received the maximum penalty in the lowest peer group.<sup><a href="#fn1">1</a></sup></li> </ul> <p>This new analysis adds to more than 15 years of research suggesting that POHs select their patients by avoiding less profitable Medicaid and uninsured patients, treat fewer medically complex patients, and provide fewer emergency services. Beyond validating findings by the Government Accountability Office, <strong><a href="https://oig.hhs.gov/oei/reports/oei-02-06-00310.pdf" target="_blank">Health and Human Services Office of Inspector General</a></strong>, and the <strong><a href="https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/Mar05_SpecHospitals.pdf" target="_blank">Medicare Payment Advisory Commission</a></strong> that POHs do not treat the same scope, complexity, or acuity of patients as non-POHs within the same market, this analysis also shows that POHs have higher average penalties for readmissions compared to full-service community hospitals. In short, by choosing the healthiest and wealthiest patients, POHs pose program integrity, access and health equity risks for the Medicare program.</p> <p><span><strong>The latest analysis from Dobson | DaVanzo once again reaffirms the need to maintain current law banning physician self-referrals to new POHs and restricting the growth of existing POHs.</strong></span></p> <hr> <ol> <li id="fn1"><a href="https://kffhealthnews.org/news/hospital-penalties/readmissions/" target="_blank">https://kffhealthnews.org/news/hospital-penalties/readmissions/</a></li> </ol> </div> <div class="col-md-4"> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2023/08/New-Analysis-Validates-Need-to-Preserve-Restrictions-on-the-Growth-of-Physician-owned-Hospitals.pdf" target="_blank" title="Click here to download the New Analysis Validates Need to Preserve Restrictions on the Growth of Physician-owned Hospitals PDF.">Click here to download the Overview PDF</a></div> <p><a href="/system/files/media/file/2023/08/New-Analysis-Validates-Need-to-Preserve-Restrictions-on-the-Growth-of-Physician-owned-Hospitals.pdf" target="_blank" title="Click here to download the New Analysis Validates Need to Preserve Restrictions on the Growth of Physician-owned Hospitals PDF."><img alt="New Analysis Validates Need to Preserve Restrictions on the Growth of Physician-owned Hospitals page 1." data-entity-type="file" data-entity-uuid="c0138c7a-1726-47bb-ab9e-5f89bc11a1b3" src="/sites/default/files/inline-images/Page-1-New-Analysis-Validates-Need-to-Preserve-Restrictions-on-the-Growth-of-Physician-owned-Hospitals.png" width="691" height="900"></a></p> </div> </div> </div> Thu, 03 Aug 2023 06:15:00 -0500 Star Ratings /guidesreports/2023-08-03-analysis-selected-medicare-quality-measure-reporting-data-hospital-ownership <div class="container"> <div class="row"> <div class="col-md-8"> <h2>Introduction</h2> <p>Dobson | DaVanzo recently examined Medicare claims data comparing demographic and clinical characteristics of facilities and patients receiving care at physician-owned hospitals (POHs) and all other acute care hospitals (non-POHs). That report showed that relative to POHs, non-POHs care for older, more medically complex patients who are on average burdened with multiple co-morbid conditions, while also operating on lower margins and providing more uncompensated and unreimbursed care. Building on this work, we now investigate to what extent differences exist among these hospital groups on their reporting and performance in Medicare’s Hospital Star Rating Domains and Hospital Readmissions Reduction Program (HRRP).<sup><a href="#fn1">1</a></sup> This document outlines the data and methods used and summarizes preliminary findings.</p> <h2>Data and Methods</h2> <p>The POHs represented in this fact sheet were identified based primarily on a June 2016 Physician Hospitals of America list and subsequent FAH/AHA review. Non-POHs are defined as the remaining acute care hospitals that are paid under the inpatient hospital prospective payment system (IPPS) defined under Section 1886(d) of the Social Security Act.<sup><a href="#fn2">2</a></sup> For this analysis, market areas are defined as hospital referral regions (HRRs) from the Dartmouth Atlas of Healthcare, which are made up of zip code area groupings based on the referral patterns of tertiary medical care.<sup><a href="#fn3">3</a></sup> Using data from the January 2023 Hospital General Information file and FY 2023 Hospital Readmissions Reduction Program (HRRP) Supplemental file produced by CMS, we conducted descriptive analyses to compare POHs with non-POHs in POH market areas. POH market areas are defined as any HRR with at least one POH.</p> <h2>Hospital Compare Star Rating Domains Analysis Findings</h2> <p>As shown in Table 1 below, POHs generally reported fewer measures in each of the Hospital Compare Star Rating domains as compared to non-POHs in POH markets. The one exception is the Patient Experience domain, where POHs report a slightly higher average number of measures as compared to non-POHs in POH markets. This further demonstrates that POHs do not treat the same scope, complexity or acuity of patients compared to non-POHs.</p> <hr> <h3>Table 1: Average Count of Measures used in the Overall Hospital Compare Star Rating by Domain, POH vs. Non-POH in POH Markets</h3> <table> <tbody> <tr> <th>Hospital Group</th> <th>Number of Hospitals</th> <th>Average Count of Facility Mortality Measures</th> <th>Average Count of Facility Safety Measures</th> <th>Average Count of Facility Readmission Measures</th> <th>Average Count of Facility Patient Experience Measures</th> <th>Average Count of Facility Timely and Effective Care Measures</th> </tr> <tr> <td>POH</td> <td>158</td> <td>1.3</td> <td>2.8</td> <td>4.3</td> <td>7.1</td> <td>2.9</td> </tr> <tr> <td>Non-POHs in POH Markets</td> <td>1,184</td> <td>4.6</td> <td>5.0</td> <td>7.7</td> <td>7.0</td> <td>6.4</td> </tr> <tr class="bold-faced"> <td>Total</td> <td>1,342</td> <td>4.2</td> <td>4.7</td> <td>7.3</td> <td>7.0</td> <td>6.0</td> </tr> <tr class="bold-faced"> <td>% Difference (POH and Non-POH)</td> <td> </td> <td>111.7%</td> <td>55.4%</td> <td>56.1%</td> <td>2.6%</td> <td>75.4%</td> </tr> </tbody> </table> <p>Notes:</p> <p>Non-acute care hospitals, hospitals that do not participate in in the Inpatient Quality Reporting (IQR) and Outpatient Quality Reporting (OQR) programs (identified via Hospital General Information file footnote 19), and Department of Defense hospitals are excluded.</p> <p>Non-POH hospitals are restricted to those located in the same market as a POH (86 HRRs).</p> <p>The count of facility measures was set to 0 for a facility's domain when the count of measures reported was 'not available' and CMS General information file footnote 5 ('Results are not available for this reporting period') was present.</p> <p>Data shown are rounded to the nearest tenth decimal place. Percent difference is calculated from the unrounded POH and Non-POH average measure count data. Source: Dobson | DaVanzo analysis of 2023 Hospital General Information file produced by CMS.</p> <hr> <h2>Hospital Readmissions Reduction Program (HRRP) Analysis Findings</h2> <p>Hospitals are organized into peer groups in the Hospital Readmissions Reduction Program to measure relative performance on HRRP measures among hospitals that are similarly situated. Congress mandated that CMS implement peer groups in the HRRP beginning on October 1, 2018 in order to account for the influence of health-related social needs on readmissions performance. Peer grouping is designed to facilitate more equitable performance comparisons and payment adjustments across hospitals in the HRRP. These peer groups are defined based on the proportion of a hospital’s care provided to patients who are dually-eligible for Medicare and Medicaid. Dual-eligible proportion is intended to serve as a proxy for the prevalence of health-related social needs among the patients that hospitals serve. Hospitals are peer grouped with other hospitals serving similar proportions of dual-eligible patients and have their readmissions measure performance compared to other hospitals within their peer group.</p> <p>Based on an analysis of FY 2023 HRRP results, the majority of POHs fall into the lowest dual-eligible proportion peer group, which indicates that they treat smaller proportions of dual-eligible patients as compared to non-POHs. Additional detail is shown in Chart 1, below.</p> <h3>Chart 1: Distribution of Hospitals in HRRP Peer Groups in POH Markets</h3> <p><img alt="Distribution of Hospitals in HRRP Peer Groups in POH Markets. HRRP Peer Groups go from lower proportion of dual-eligible patients to higher proportion of dual eligible patients. Group 1: 78% of POHs; 19% of Non-POHs in POH Markets. Group 2: 7% of POHs; 24% of Non-POHs in POH Markets. Group 3: 6% of POHs; 23% of Non-POHs in POH Markets. Group 4: 4% of POHs; 18% of Non-POHs in POH Markets. Group 1: 5% of POHs; 16% of Non-POHs in POH Markets. Source: Dobson | DaVanzo analysis of FY 2023 Hospital Readmissions Reduction Program (HRRP) Supplemental file produced by CMS." data-entity-type="file" data-entity-uuid="8f7ffe68-5706-4918-82d2-13d7cf9a837c" src="/sites/default/files/inline-images/Chart-1-Distribution-of-Hospitals-in-HRRP-Peer-Groups-in-POH-Markets.jpg" width="1181" height="790"></p> <p><small>Source: Dobson | DaVanzo analysis of FY 2023 Hospital Readmissions Reduction Program (HRRP) Supplemental file produced by CMS.</small></p> <p>This finding is consistent with our prior report showing that non-POHs competing with POHs treated 10.7% more dual-eligible patients relative to POHs. In addition, because POHs tend to specialize in selected medical conditions, only 1.3 of the 5 conditions<sup><a href="#fn4">4</a></sup> on average have sufficient volume (25 cases or more) volume to qualify for the HRRP composite measure compared to an average of 3.5 conditions for non-POHs in the Lowest Dual-Eligible Proportion Peer Group. Although the HRRP composite metric consists of only specific conditions that POHs treat, they receive higher Medicare penalties than non-POHs that treat a broader set of conditions and are subjected to more conditions included in the HRRP composite measure. Additional detail is provided in the points and Table 2, below.</p> <ul> <li>119 POHs (78% of all POHs) were in the lowest dual-eligible proportion peer group compared to 216 non-POHs (19% of all non-POHs). Hospitals in this peer group have the lowest proportion of dual-eligible patients.</li> <li>Of the 119 POHs in the lowest dual-eligible proportion peer group, 8 hospitals (6.7%) received the maximum HRRP penalty of 3% in FY2023, compared to only 1 of the 216 non-POHs (0.5%) in the same market.</li> <li>The average HRRP payment reduction percentage for POHs in the lowest dual-eligible proportion peer group was 0.4% compared to non-POHs in the same market of 0.3%.</li> <li>On average only 1.3 of the 5 conditions4 have enough volume to qualify for the HRRP composite measure for POHs in the lowest dual-eligible proportion peer group compared to 3.5 for non-POHs in the same market and dual-eligible proportion peer group.</li> </ul> <hr> <h3>Table 2: Medicare HRRP Penalties and Average Number of Conditions Eligible for HRRP Composite Measure for POHs Compared to Non-POHs in the Lowest Dual-Eligible Proportion Peer Group</h3> <table> <tbody> <tr> <th>Hospital Group</th> <th>Number of Hospitals</th> <th>Average HRRP Payment Reduction Percentage</th> <th>Percent Hospitals with Max HRRP Penalty</th> <th>Average Number of Conditions Eligible for HRRP Composite Measure</th> </tr> <tr> <td>POHs</td> <td>119</td> <td>0.4%</td> <td>6.7%</td> <td>1.3</td> </tr> <tr> <td>Non-POHs in POH Markets</td> <td>216</td> <td>0.3%</td> <td>0.5%</td> <td>3.5</td> </tr> </tbody> </table> <p>Notes:</p> <p>POHs and non-POHs were stratified based on dual-eligibility peer group, which consists of five peer groups based on the hospital’s dual proportion.<sup><a href="#fn5">5</a></sup></p> <p>The HRRP measure is a composite metric that includes hospital excess readmission rates within five conditions/procedures.<sup><a href="#fn6">6</a></sup></p> <p>A hospital must have at least 25 Medicare discharges within condition/procedure for that condition/procedure to be included in the composite metric.</p> <p>Source: Dobson | DaVanzo analysis of FY 2023 Hospital Readmissions Reduction Program (HRRP) Supplemental file produced by CMS.</p> <hr> <h2>Conclusion</h2> <p>As compared to non-POHs in the same market as a POH, POHs appear to report fewer measures in most of the CMS Hospital Compare Star Ratings Domains and are less likely to have adequate volume to qualify for the full breadth of HRRP measures. This suggests POHs are accountable for a narrower scope of quality measure performance than non-POHs. POHs have sometimes asserted that offering more focused services facilitates stronger quality performance. Yet, this analysis shows POHs appear to have slightly higher average readmission penalties. POHs also are disproportionately more likely than similarly situated non-POH hospitals to experience the maximum HRRP penalty. These findings build on our prior work that shows POHs care for a less medically complex Medicare population than non-POHs./p></p> <hr> <ol> <li id="fn1">This study was commissioned by the Federation of ����������s (FAH) and the ���������� Association (AHA).</li> <li id="fn2">Critical Access Hospitals (small rural hospitals), Psychiatric Hospitals, Inpatient Rehabilitation Facilities, Long Term Care Hospitals, and Pediatric Hospitals are excluded.</li> <li id="fn3"><a href="https://www.dartmouthatlas.org/research-methods/" target="_blank">https://www.dartmouthatlas.org/research-methods/</a>.</li> <li id="fn4">4 Note that six measures are typically included in HRRP. However, CMS suppressed one of the measures (pneumonia readmissions) for FY 2023 due to the COVID-19 Public Health Emergency; see <a href="https://qualitynet.cms.gov/inpatient/hrrp/measures" target="_blank">https://qualitynet.cms.gov/inpatient/hrrp/measures</a>.</li> <li id="fn5">Dual proportion is the proportion of Medicare fee-for-service (FFS) and managed care stays in a specific hospital, where the patient was dually eligible for Medi-care and full-benefit Medicaid during the FY 2018 HRRP performance period (July 1, 2013 to June 30, 2016).</li> <li id="fn6">Acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, coronary artery bypass graft, and elective primary total hip and/or knee arthroplasty.</li> </ol> </div> <div class="col-md-4"> <p><a href="/system/files/media/file/2023/08/Analysis-of-Selected-Medicare-Quality-Measure-Reporting-Data-by-Hospital-Ownership.pdf" target="_blank" title="Click here to download the Analysis of Selected Medicare Quality Measure Reporting Data by Hospital Ownership report PDF."><img alt="Analysis of Selected Medicare Quality Measure Reporting Data by Hospital Ownership page 1." data-entity-type="file" data-entity-uuid="ee790405-64bc-4c09-8a66-33987dd21320" src="/sites/default/files/inline-images/Page-1-Analysis-of-Selected-Medicare-Quality-Measure-Reporting-Data-by-Hospital-Ownership.png" width="695" height="900"></a></p> </div> </div> </div> table, th, td { border: 1px solid black; border-collapse: collapse; } tr.bold-faced { font-weight: bold; } th { background-color: #78be2026; } Thu, 03 Aug 2023 06:00:00 -0500 Star Ratings <div class="container"> <div class="row"> <div class="col-md-8"> <p>The Centers for Medicare & Medicaid Services (CMS) Dec. 14 released its proposed Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Program for Contract Year (CY) 2024. The <a href="https://public-inspection.federalregister.gov/2022-26956.pdf" target="_blank" title="HHS: Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications.">proposed rule</a> would increase oversight of Medicare Advantage (MA) plans and better align them with Traditional Medicare, address access gaps in behavioral health services and further streamline prior authorization processes, supplementing a separate <a href="https://www.federalregister.gov/documents/2022/12/13/2022-26479/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-advancing-interoperability" target="_blank" title="Federal Register: Medicare and Medicaid Programs: Application From the Center for Improvement in Healthcare Quality for Initial CMS Approval of Its Critical Access Hospital Accreditation Program">proposal</a> last week.</p> <p>The rule also would provide specific protections to ensure post-acute care services covered by Traditional Medicare cannot be denied by an MA plan or inappropriately redirected to a lower level of care. In addition, the rule would tighten MA marketing standards to protect beneficiaries from misleading advertisements and pressure tactics; expand requirements for MA plans to provide culturally and linguistically appropriate services; make changes to MA star ratings to address social determinants of health; and implement Inflation Reduction Act provisions to make prescription drugs more affordable for eligible low-income individuals.</p> <h2>AHA Take</h2> <p>The AHA is increasingly concerned about certain MA plan policies that restrict or delay patient access to care, which also add cost and burden to the health care system. These concerns were validated by a <a href="https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp?hero=mao-report-04-28-2022" target="_blank" title="HHS: Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care">report</a> issued by the Office of Inspector General (OIG) earlier this year showing that some MA plans have exhibited a pattern of denying prior authorization and payment requests that would have been covered under Traditional Medicare. These findings, and the broader experience of hospitals and health systems, reflects that certain commercial insurer policies can be harmful to patients and the providers who care for them. Accordingly, the AHA supports proposals to increase health plan accountability and strengthen consumer protections.</p> <p>In a statement yesterday, Ashley Thompson, AHA senior vice president of public policy analysis and development, said, “The AHA commends CMS for taking important steps to increase oversight of Medicare Advantage plans to help ensure enrollees have equal access to medically necessary health care services that should be covered. The AHA has previously raised concerns about the negative effects of certain Medicare Advantage practices and policies that have the potential to directly harm patients through unnecessary care delays or outright denial of covered services. CMS’ proposed rule includes helpful provisions to ensure more consistency between Medicare Advantage and traditional Medicare by curtailing overly restrictive policies that can impede access to care and add cost and burden to the health care system. We also applaud CMS’ attention to access gaps in behavioral health services.”</p> <p>“The AHA will continue to carefully review the proposed rule and support efforts to improve the Medicare Advantage program for patients and their providers.”</p> <p>For additional detail, the <a href="https://www.cms.gov/newsroom/fact-sheets/contract-year-2024-policy-and-technical-changes-medicare-advantage-and-medicare-prescription-drug" target="_blank" title="CMS: Contract Year 2024 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs Proposed Rule (CMS-4201-P)">CMS Fact Sheet</a> on the proposed rule summarizes key provisions. <strong>Comments are due to CMS by Feb. 13, 2023.</strong></p> <h2>Highlights of the Proposed Rule</h2> <h3>Prior Authorization and Medical Necessity Determinations</h3> <p>CMS proposes several updates designed to curtail improper MA plan prior authorization processes and ensure MA beneficiaries receive timely and appropriate access to medically necessary care. Specifically, the agency clarifies that MA plans may only utilize prior authorization processes to confirm whether a patient’s care is medically necessary, addressing concerns that plans were creating non-clinical barriers to care in their programs.</p> <p>Additionally, the proposed rule requires that MA plans adhere to Traditional Medicare coverage policies when making a medical necessity determination and cannot utilize alternative criteria to deny coverage of an item or service that would be approved under CMS rules. The rule provides specific examples in the arena of post-acute care, which the OIG report identified as a service category with frequent rates of inappropriate denials, citing that MA plans cannot, for example, deny coverage or redirect to a lower level of care unless the patient explicitly does not meet the Medicare coverage criteria required for the recommended level of care.</p> <p>If a service does not have established coverage criteria under Traditional Medicare rules, plans may adopt criteria based on widely used treatment guidelines or clinical literature only if the plan creates a publicly accessible summary of the evidence, a list of the sources, and an explanation of the rationale for the internal coverage criteria.</p> <p>To promote clinical validity, CMS proposes that a physician or other appropriate health care professional reviewing a request for prior authorization, or a coverage denial must have expertise in the field of medicine related to the service being requested. Additionally, to ensure that plan policies are adequately reviewed and currently appropriate, the rule requires plans to establish a Utilization Management Committee led by the plan’s medical director. This committee would be required to conduct an annual review of plan prior authorization and other utilization management polices to ensure compliance with Medicare rules and consistency with current clinical guidelines.</p> <p>Furthermore, the proposal would require prior authorizations to be valid for the entirety of a prescribed treatment. This would prevent plans from approving a reduced number of days of prescribed treatments or requiring additional prior authorizations for each treatment in a series prescribed by a provider. Plans also must have policies that permit no less than 90 days transition for new beneficiaries on established treatments prior to enrolling with the plan.</p> <h3>Behavioral Health Access</h3> <p>CMS proposes several provisions that would establish standards for access to behavioral health services under MA. Currently, MA plans are required to provide access to an adequate network of “appropriate providers,” including primary care providers, specialists, hospitalists and others; this rule would explicitly add providers that specialize in behavioral health services to this list. Plans also are required to demonstrate that the network includes an adequate supply of psychiatrists and inpatient psychiatric facilities for the population served. This rule would further require plans also to include an adequate supply of clinical psychologists, licensed clinical social workers and prescribers of medication for opioid use disorder in their networks.</p> <p>In accordance with these additions, CMS would require plans to ensure that specified behavioral health providers would be available in a certain time frame (i.e., number of days until an appointment) and travel distance. The agency considered literature and several sources of data to calculate the projected need for behavioral health practitioners to determine adequacy standards, including prevalence of behavioral health disorders among Medicare beneficiaries and Health Resources & Services Administration’s (HRSA) Health Workforce Simulation Model. Additionally, CMS would add behavioral health services to the types of services for which MA plans must have programs in place to ensure continuity of care and integration of services.</p> <p>Finally, CMS proposes to add language to regulations that would definitively clarify that an emergency medical condition can be physical or mental. This language would require MA organizations to ensure that MA enrollees receive medically necessary behavioral health services in a medical emergency, which would not be subject to prior authorization.</p> <h3>MA Star Ratings</h3> <p>CMS proposes a number of significant changes to the Star Ratings program for MA and Part D plans. To encourage health plans to improve performance for patients with certain social risk factors, CMS would replace its current reward factor for consistently high star ratings performance with a new health equity index (HEI) reward. The HEI reward would be calculated by assessing each plan’s performance on selected measures for enrollees that are dually eligible for Medicare and Medicaid, receive the Part D Low Income Subsidy (LIS) or are disabled. Plans’ performance for the selected measures would be compared to one another, with plans receiving points for each measure corresponding to their level of performance. The resulting HEI would be converted into a HEI reward factor in determining the plan’s star rating.</p> <p>CMS also proposes to:</p> <ul> <li>Reduce the weight of patient experience/complaints and access measures by half;</li> <li>Remove the bi-directional caps on how much the cut points in determining measure performance can move from the prior year; and</li> <li>Limit the availability of its improvement measure hold harmless policy to only contracts with 5 stars for their highest rating starting in 2026.</li> </ul> <h3>Advancing Health Equity</h3> <p>CMS proposes clarifications and expansions of several existing MA regulations intended to advance health equity for all enrollees. Specifically, CMS would clarify its requirement to provide culturally competent care by expanding the list of populations to which plans would be expected to provide culturally competent services. It also proposes to ensure that enrollees with low digital health literacy are identified and offered digital health education to improve access to medically necessary covered telehealth benefits. In addition, the proposed rule requires plans to include additional provider details in their provider directories, including cultural/linguistic capabilities, accessibility for people with physical disabilities, and whether the provider can provide medications for opioid use disorders. Finally, the proposed rule would require plans to incorporate one or more activities in their Quality Improvement programs targeted at reducing disparities in health and health care among their enrollees.</p> <h3>Restricting Marketing</h3> <p>The proposed rule contains a variety of provisions designed to restrict MA plan marketing practices that may be misleading to consumers, increase oversight of third-party marketing agents used by MA plans, and prohibit pressure tactics designed to facilitate enrollment. Specifically, the proposed rule would prohibit advertisements for MA plans that do not mention a specific plan name, as well as those that use words or imagery (for example the Medicare name or logo) intended to mislead or confuse potential beneficiaries, such as trying to make it appear the information is from a government agency. The proposed rule also seeks to ban sales presentations immediately following educational events and further restrict other sales interactions that may involve pressuring consumers while presenting only a subset of plan options. In addition, the rule would require sales agents to disclose to prospective beneficiaries information about all the plans the agent sells; describe information that can be obtained from Medicare.gov; and review a standardized list of questions and pre-enrollment checklist with any prospective beneficiary. Agents would also be required to explain the effects of a prospective beneficiary’s enrollment choices on their coverage.</p> <h3>Prescription Drug Affordability and Access</h3> <p>The proposed rule seeks to make several changes to Part D plan sponsor requirements including:</p> <ul> <li>Allowing greater formulary flexibility for substitution of certain biological products and authorized generics.</li> <li>Expanding access to Medication Therapy Management programs by broadening eligibility criteria to include medications related to treatment of HIV/AIDS, and by lowering eligibility thresholds, making it easier for patients with complex medication needs to qualify.</li> </ul> <p>In addition, the proposal seeks to implement provisions of the Inflation Reduction Act by expanding access to low-income subsidies available under Part D and making permanent the limited income newly eligible transition (LINET) program. The LINET currently operates as a demonstration program providing immediate and retroactive Part D coverage for certain low-income beneficiaries who do not yet have prescription drug coverage.</p> <h2>Further Questions</h2> <p>If you have further questions, please contact Michelle Millerick, AHA’s senior associate director of health insurance & coverage policy, at <a href="mailto:mmillerick@aha.org?subject=RE: Special Bulletin: CMS Issues Proposed Rule for CY 2024 Medicare Advantage, Prescription Drug Plans">mmillerick@aha.org</a> or Terry Cunningham, AHA’s director of administrative simplification policy, at <a href="mailto:tcunningham@aha.org?subject=RE: Special Bulletin: CMS Issues Proposed Rule for CY 2024 Medicare Advantage, Prescription Drug Plans">tcunningham@aha.org</a>.</p> </div> <div class="col-md-4"> <p><a href="/system/files/media/file/2022/12/Special-Bulletin-CMS-Issues-Proposed-Rule-for-CY-2024-Medicare-Advantage-Prescription-Drug-Plans.pdf" target="_blank" title="Click here to download the Special Bulletin: CMS Issues Proposed Rule for CY 2024 Medicare Advantage, Prescription Drug Plans PDF."><img alt="Special Bulletin: CMS Issues Proposed Rule for CY 2024 Medicare Advantage, Prescription Drug Plans page 1." data-entity-type="file" data-entity-uuid="d3393fb4-352c-40da-8fbe-0f13a464cc7a" src="/sites/default/files/inline-images/Page-1-Special-Bulletin-CMS-Issues-Proposed-Rule-for-CY-2024-Medicare-Advantage-Prescription-Drug-Plans.png" width="702" height="900"></a></p> </div> </div> </div> Fri, 16 Dec 2022 09:20:29 -0600 Star Ratings /news/headline/2022-07-27-cms-updates-overall-hospital-quality-star-ratings <p>The Centers for Medicare & Medicaid Services today updated with 2021 data the Overall Hospital Quality Star Ratings at its <a href="https://www.medicare.gov/care-compare/">Care Compare</a> website and <a href="https://data.cms.gov/provider-data/">Provider Data Catalog</a>. The anticipated update is the second since the agency overhauled the ratings’ methodology in 2020. </p> <p>“The AHA appreciates many of the recent changes that CMS has made to its Overall Star Ratings program, which have made the ratings easier for patients and hospitals to interpret, more transparent, and more balanced in favor of high-priority topics,” said Akin Demehin, AHA’s senior director of quality and patient safety policy. “However, we believe that CMS still has work to do to improve the Overall Star Ratings program. For example, while we agree with the intent of CMS’ peer grouping approach — that is, to create a more level playing field among hospitals offering differing levels of care — we believe it still needs improvement to ensure it fosters equitable comparisons. We also have encouraged CMS to examine the influence of social drivers of health on star ratings, and consider approaches to ensure the ratings are not unintentionally biased against those hospitals caring for structurally marginalized communities. Hospitals and health systems are longstanding supporters of transparency and are committed to continuing to work with CMS to advance the goal we share — providing the public with accurate, meaningful information about quality.” </p> Wed, 27 Jul 2022 15:32:16 -0500 Star Ratings /news/headline/2022-07-14-report-hospital-star-ratings-methodology-remains-volatile-smaller <p>The Centers for Medicare & Medicaid Services’ new Hospital Overall Star Ratings methodology preserves some year-to-year stability, but ratings remain volatile for hospitals reporting fewer measures and still don’t provide an apples-to-apples comparison of hospitals, according to <a href="/2022-07-12-understanding-cms-changes-hospital-overall-star-ratings">an analysis</a> by KNG Health Consulting commissioned by AHA. CMS implemented the new methodology in 2020 and expects this month to update the ratings with 2021 data.  <br />  <br /> “Based on this analysis, it’s clear that CMS has more work to do to ensure that these ratings are equitable,” write AHA’s Akin Demehin, senior director of quality and patient safety policy, and John Allison, associate director of health analytics and policy, at the <a href="/news/blog/2022-07-14-blog-understanding-cms-changes-hospital-overall-star-ratings">AHA Stat Blog.  </a><br />  </p> Thu, 14 Jul 2022 14:45:14 -0500 Star Ratings /news/blog/2022-07-14-blog-understanding-cms-changes-hospital-overall-star-ratings <p>In 2020, the Centers for Medicare & Medicaid Services (CMS) overhauled the Hospital Overall Quality Star Ratings methodology with the expressed purpose of making ratings more transparent, equitable, stable and predictable. AHA commissioned KNG Health to assess whether these methodological changes have fully achieved CMS' goals, while also estimating expected performance variation and drivers of performance and variation under the new methodology. Based on this analysis, it’s clear that CMS has more work to do to ensure that these ratings are equitable.</p> <p>The analysis revealed that while CMS’s new Overall Star Ratings methodology preserves some year-to-year stability, ratings remain volatile for hospitals reporting fewer measures. This was particularly true for smaller, rural hospitals and critical access hospitals (CAHs). The analysis also found that under CMS’ new peer grouping approach, 74% of hospitals are scored on all five measure groups, but the remaining 26% split across the 14 combinations of three to four measure groups — meaning a hospital’s star ratings can reflect very different sets of measure groups. This means these ratings still don’t provide an apples to apples comparison of hospitals.</p> <p>Ongoing systematic assessment of the methodology will be vital, and CMS should evaluate potential approaches that make the basis of ratings more equitable. AHA also urges CMS to consider:</p> <ul> <li>Moving away from an overall rating, and instead explore approaches for scoring hospitals on individual topics.</li> <li>Assessing the peer grouping approach to see whether factors other than number of reported measure groups could be used, such as number of measures, or CAH/Inpatient Prospective Payment System status.</li> <li>Ensuring any public messaging aground Overall Star Ratings reflect that the rating is a function of the measures used in scoring as well as other methodological choices.</li> <li>Replacing unstable measures that examine rare events with more robust measures of safety and quality so that more hospitals have sufficient data to be compared on more measures.</li> </ul> <p>View the full report <a href="/2022-07-12-understanding-cms-changes-hospital-overall-star-ratings" target="_blank">here</a>.</p> Thu, 14 Jul 2022 08:20:34 -0500 Star Ratings /2022-07-12-understanding-cms-changes-hospital-overall-star-ratings <div class="container"> <div class="row"> <div class="col-md-4"> <div class="panel module-typeC"> <div class="panel-body"> <h3 class="text-align-center"><span>Key Findings</span></h3> <ul> <li><strong><span>CMS’ new star ratings methodology preserves some year-to-year stability, but ratings remain volatile for hospitals reporting fewer measures.</span></strong></li> <li><strong><span>Under CMS’ new peer grouping approach, 74% of hospitals are scored on all five measure groups with the remaining 26% split across the 14 combinations of measure groups.</span></strong></li> <li><strong><span>Star ratings remain volatile for hospitals reporting fewer measures, especially smaller, rural hospitals and critical access hospitals (CAHs).</span></strong></li> <li><span><strong>Ongoing systematic assessment of the methodology is vital, and CMS should evaluate potential approaches that make the basis of ratings more equitable</strong>.</span></li> </ul> </div> </div> </div> <div class="col-md-8"> <p>The Centers for Medicare & Medicaid Services (CMS) in 2020 overhauled the Hospital Overall Star Ratings methodology to make ratings more transparent, equitable, stable and predictable. To improve transparency the agency moved away from the statistically heavy and difficult to interpret latent variable modeling approach and instead employed a simple average of measure to calculate measure group scores. As a way to attempt to achieve more equitable comparisons, CMS also created peer groupings by number of reported measures. To improve the stability and predictability of star ratings the weights applied to the different measures would be set in advance by CMS. On the whole, while CMS expected the new methodology could change the overall ratings distribution, it believed period-to-period changes would remain fairly stable.</p> <p>AHA commissioned KNG Health to assess whether these methodological changes have fully achieved CMS' goals, while also estimating expected performance variation and drivers of performance and variation under the new methodology. The KNG analysis entailed:</p> <ul> <li>Comparing 2020 (old methodology) to 2021 (new methodology) hospital star ratings performance reported by CMS, assessing differences in ratings by hospital characteristics.</li> <li>Assessing the stability of CMS’ new methodology by comparing hypothetical 2020 performance under the new methodology to 2021 actual performance; and</li> <li>Assessing the equitability of the ratings through analyses of peer groupings.</li> </ul> <p>Overall the new methodology preserves some year-to-year stability. When applying the new methodology to both 2020 and 2021 the distribution of ratings are similar (see Figure 1). Sixty percent of hospitals could have expected to receive the same score in 2020, with 36% seeing an increase or decrease of one star rating. </p> <p>View the detailed issue brief below. </p> <p> </p> </div> </div> </div> Wed, 13 Jul 2022 16:22:20 -0500 Star Ratings <div class="container"> <div class="row"> <div class="col-md-8"> <p>This month, the Centers for Medicare & Medicaid Services (CMS) will refresh the Overall Hospital Quality Star Ratings (Overall Star Rating) on its Care Compare website, the second update since the agency overhauled the methodology in 2020. This year’s refresh will incorporate data from 2021 into the newest ratings. While the overall ratings methodology remains unchanged from last year, some hospitals may experience significant shifts in the number of stars they receive from one year to the next due to changes in what measures are included, underlying measure performance and the design of the ratings methodology.</p> <div class="panel module-typeC"> <div class="panel-body"> <h3><span>Key Highlights</span></h3> <p>This second application of the revised methodology:</p> <ul> <li>Continues to calculate hospital performance on up to five weighted measure groups using a simple average of the measures in the group.</li> <li>Continues to only assign a rating to hospitals reporting minimum number of measures in certain groups.</li> <li>Continues to assign hospitals to peer groups based on the number of measure groups reported.</li> <li>Includes 234 fewer hospitals than last year due to COVID-19 data exceptions</li> </ul> </div> </div> <h2>AHA TAKE</h2> <p>Hospitals and health systems have long supported transparency on quality. While some of the revisions included in the star ratings methodology have improved transparency by moving away from the statistically heavy and difficult to interpret approach used in the past, AHA continues to be skeptical about whether quality rankings or rating scores can meaningfully reflect hospital performance without bias.</p> <h2>WHAT YOU CAN DO</h2> <ul> <li>Share this advisory with your chief quality officer, clinical leaders and media team.</li> <li>Review preview reports on the <a href="https://hqr.cms.gov/hqrng/login">Hospital Reporting page</a> of QualityNet to understand the basic approach of star ratings and your organization’s performance. KEY HIGHLIGHTS This second application of the revised methodology:</li> <li>Use the talking points included in this Advisory to help prepare for questions about your organization’s performance.</li> <li>Be ready to speak to performance improvement efforts related to the measures and topics in star ratings.</li> </ul> <h2>BACKGROUND ON OVERALL HOSPITAL STAR RATINGS</h2> <p>In July 2016, CMS began to report an overall star rating reflecting performance on nearly 60 Hospital Compare measures. At the time, the <a href="/letter/2016-07-07-hospital-organizations-urge-cms-address-serious-concerns-about-star-ratings">AHA with other hospital associations</a>, the <a href="/news/headline/2016-04-19-225-house-members-urge-cms-delay-overall-hospital-quality-star-ratings" target="_blank">majority of Congress</a> and many other stakeholders voiced significant concerns about the accuracy and meaningfulness of the ratings, and urged CMS not to publish the ratings unless and until they could be improved. The agency continued to update and publish the ratings despite this opposition. After modest changes to the methodology in the years that followed (which you can read about in AHA’s January 2020 <a href="/advisory/2020-01-15-member-advisory-cms-star-ratings-refresh-expected-month-bigger-changes-possible" target="_blank">Member Advisory</a>), CMS issued a request for information (RFI) that solicited feedback on a wide range of possible changes, some fundamental. Using responses to this RFI, including from the AHA, CMS proposed several changes in the calendar year (CY) 2021 outpatient prospective payment system proposed rule and finalized many, but not all, of the changes. CMS applied the newly revised methodology to data informing the April 2021 Hospital Care Compare star ratings refresh.</p> <p>CMS intended to update the star ratings on Care Compare in April 2022 as scheduled; however, the agency identified an error in the calculation of CY 2021 results for a single measure (OP-10: Abdomen Computer Tomography—Use of Contrast Material). In a “commitment to data accuracy,” CMS updated the 2021 OP-10 measure results, which are used to calculate performance in the Timely and Effective Care measure group, as well as the overall star ratings to correct the error.</p> <h2>Overview of Star Ratings Methodology</h2> <p>CMS determines an individual hospital’s star rating using several steps described below. A comparison of the current methodology with the previous approach, as well as an explanation of the rationale behind these revisions, can be found in AHA’s 2021 <a href="/system/files/media/file/2021/03/revised-hospital-star-ratings-details-help-you-prepare-for-april-2021-public-release-advisory-3-1-21.pdf?check_logged_in=1" target="_blank">Member Advisory</a>.</p> <h3>Step 1: Select and Standardize Measures</h3> <p>From the universe of available quality measures comprising CMS’ Inpatient and Outpatient Quality Reporting Programs, the Hospital Value-based Purchasing program, the Hospital Readmissions Reduction Program and the Hospital-Acquired Condition Program, CMS selects the measures to include in the ratings using a number of criteria. The agency then standardizes measure scores (i.e. puts them onto a common scale) by calculating z-scores; z-scores describe the hospital’s performance relative to the mean of all scores rather than as a discrete value. This way, performance on a measure assessed with a rate, for example, can be combined with performance on a measure assessed on a binary (yes/no) scale.</p> <h3>Step 2: Assign Measures to Groups</h3> <p>The measures selected to be used in the calculation are assigned to one of five measure groups. Each group is weighted in its contribution toward the total score:</p> <ul> <li>Mortality (22%)</li> <li>Safety of Care (22%)</li> <li>Readmissions (22%)</li> <li>Patient Experience (22%)</li> <li>Timely and Effective Care (12%)</li> </ul> <h3>Step 3: Calculate Measure Group Scores</h3> <p>CMS calculates a hospital’s performance in each group with a simple average based on the following steps:</p> <ol> <li>Weighting each measure within a group based on the number of measures in that group that the hospital reported;</li> <li>Summing the weighted measure scores to calculate the group score; and</li> <li>Standardizing the group score using a z-score.</li> </ol> <ul> <li>The z-score is calculated by subtracting the national average group score from each hospital’s measure group score and dividing by the measure group’s national standard deviation. This step allows for interpretation of the score relative to — i.e., better or worse than — the national average.</li> </ul> <h3>Step 4: Combine Measure Group Scores into a Summary Score.</h3> <p>The summary score is the weighted average of up to five measure group scores using the weights described in Step 2. If a hospital has insufficient data for an individual group, the group’s weight is redistributed proportionally across the remaining measure groups.</p> <h3>Step 5: Apply Star Ratings Reporting Thresholds</h3> <p>CMS will only assign a star rating to hospitals that report at least three measures in at least three measure groups, and one of those groups must be “Mortality” or “Safety of Care.”</p> <h3>Step 6: Assign Hospitals to a Peer Group</h3> <p>Hospitals that meet the reporting threshold are assigned to a peer group for comparison based on the number of measure groups they report: 1) Hospitals reporting all five measure groups; 2) hospitals reporting four measure groups; 3) hospitals reporting three measure groups. Peer groups are not publicly reported.</p> <h3>Step 7: Calculate Overall Star Rating</h3> <p>Finally, to translate the summary score into a star rating, CMS applies a modeling technique called “k-means clustering.” This algorithm groups hospitals with similar summary scores within each peer group. The model is run many times, to “complete convergence,” meaning that the clusters of hospitals are correctly grouped: each hospital in the cluster has a summary score that is statistically comparable to every other hospital in that cluster. Then CMS assigns a rating of 1, 2, 3, 4 or 5 stars to each cluster (5 being best).</p> <h2>UPDATES TO 2022 STAR RATINGS</h2> <p>While CMS did not make changes to the underlying methodology of the star ratings for the July 2022 update, it did revise which individual measures are included in the program in regard to the July 2021 Care Compare data (which are reflected in the July 2022 refresh). First, CMS removed two measures from the Timely and Effective Care measure group: OP-30, Colonoscopy interval for patients with a history of adenomatous polyps — avoidance of inappropriate use, and ED-2b, Average time patients spent in the emergency department (ED) after the doctor decided to admit them as an inpatient before leaving the ED for their inpatient room.</p> <p>Second, CMS granted hospitals exceptions for the first six months of 2020 in light of the COVID-19 pandemic. This means that these six months of data were excluded from all measure calculations. Because of these exceptions, several measures had shorter measurement periods than normal; in addition, a small number of hospitals no longer had sufficient volume to meet the reporting thresholds, and thus will not receive a star rating in the July 2022 update.</p> <h3>Estimated Distribution of Star Ratings</h3> <p>According to the July 2022 Updates and Specifications <a href="https://qualitynet.cms.gov/files/627bb14cb1ccb90016b538a5?filename=OverallStarRating_Jul22_QUS.pdf" target="_blank">Report</a> from CMS and its contractors, 69.5% of hospitals (3,121 out of the 4,489 on Care Compare) will receive an Overall Star Rating using the July 2021 Care Compare data. In the April 2021 update, 74% of hospitals received an Overall Star Rating, and since the outset of the program in 2016 as much as 80.3% of hospitals have received a rating. However, due to the heightened minimum measure and group thresholds in the revised methodology (as well as the data exceptions explained above), more hospitals were excluded from this year’s refresh.</p> <p>The table below shows the distribution of Overall Star Ratings for July 2022, as well as the change in distribution from last year’s refresh.</p> <img alt="Star Ratings Chart for July 2022" data-entity-type="file" data-entity-uuid="e8a9d8b3-eca4-4bf3-bee1-4784c93d7991" height="229" src="/sites/default/files/inline-images/star-rating-advisory-page-4-chart.png" width="617" class="align-center"> <p>The following table shows the distribution of Overall Star Ratings for July 2022 by peer group.</p> <p> </p> <img alt="Star Ratings by Peer Group for July 2022 Chart" data-entity-type="file" data-entity-uuid="9d6402f6-57cf-4390-9e95-4c38057fb51e" height="208" src="/sites/default/files/inline-images/star-rating-advisory-page-5-chart.png" width="662" class="align-center"></div> </div> </div> <h2>OVERALL STAR RATINGS TALKING POINTS</h2> <p>The talking points below may be helpful in responding to inquiries about your star ratings.</p> <ul> <li><strong>Hospitals have been pioneers in quality measurement and have long shared safety and quality data with the public</strong>. Patients and their families need clear information to make health care decisions.<br>  </li> <li><strong>When making health care decisions, patients should use all available tools at their disposal,</strong> such as talking with friends and family and consulting with doctors, nurses and other trusted health care providers.<br>  </li> <li><strong>(Insert name of hospital) is committed to quality and safety.</strong> In fact, we are pleased that over the past few years, we have (insert data demonstrating a significant improvement in quality or safety you hospital has made).<br>  </li> <li><strong>At (insert name of hospital), we have been working diligently to improve safety </strong>by (insert two or three examples of how your hospital has improved safety in the past few years).<br>  </li> <li><strong>We appreciate many of the recent changes that CMS has made to its Overall Star Ratings program</strong>. These changes have simplified the ratings and made it easier for hospitals to know how their score was calculated. <ul> <li>Specifically, we are pleased that CMS abandoned its latent variable modeling approach and is now calculating hospital performance by simple averages.</li> <li>CMS will also only assign a star rating if hospitals report a minimum number of measures, and requiring some of those measures to address the topics of mortality or safety.</li> <li>In addition, CMS reorganized some of the measures so individual topics would not carry an overdue amount of weight.<br>  </li> </ul> </li> <li>Overall, <strong>these changes have made the Overall Star Ratings easier to interpret, more transparent to hospitals as to how they arrived at particular ratings, and more balanced in favor of high-priority topics.</strong><br>  </li> <li><strong>However, we believe that CMS still has work to do to improve the Overall Star Ratings program.</strong> The single biggest issue continues to be the lack of a sociodemographic status (SDS) adjustment, which biases the ratings against those hospitals caring for historically marginalized patients.<br>  </li> <li><strong>In addition, while we agree with the concept behind CMS’ peer grouping approach, we believe it needs ongoing monitoring to ensure it fosters the more equitable comparisons that CMS intends.</strong> The number of reported measures is supposed to be a proxy for the complexity of patients and breadth of services that hospitals offer, and CMS chose it because it is easier to obtain than other proxies. While this step might help level the playing field when comparing hospitals and represents a step in the right direction, it remains to be seen whether the change will meaningfully differentiate unlike hospitals.<br>  </li> <li>As longstanding supporters of transparency, <strong>hospitals are committed to continuing the dialog with CMS about the goal we share — providing the public with accurate, meaningful information about quality.</strong><br>  </li> <li><strong>CMS’ Overall Star Ratings program is one of a number of sources of data and rankings of hospital performance.</strong> As with any report cards or ratings, each must be interpreted in context, and it is unlikely any one report card will provide a robust and reliable portrait of quality in a hospital. For example, some of the data used to calculate hospital grades can be years old and may not reflect more recent performance improvement efforts. In addition, not all measures apply to all patients, which can matter when report cards are used as the primary tool to select a hospital for a specific procedure.<br>  </li> <li><strong>The proliferation of scorecards means that hospitals often receive divergent ratings across different reports</strong>, even when the reports are based on some of the same measures. <ul> <li> In fact, a<a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.0201" target="_blank"> 2015 Health Affairs study</a> examining hospital performance on four rating systems showed that only 10% of the 844 studied hospitals rated as a high performer by one rating system were rated as a high performer by any of the other rating systems.<br>  </li> </ul> </li> <li><strong>Variation among numerous reports and rankings of hospital performance has caused confusion for health care professionals and patients.</strong></li> </ul> <p>To address these concerns, national hospital associations have endorsed a set of principles for evaluating publicly reported provider performance data. View the <a href="https://www.aamc.org/what-we-do/mission-areas/health-care/guiding-principles-public-reporting" target="_blank">document here</a>.</p> <h2>FURTHER QUESTIONS</h2> <p>Please contact Akin Demehin, AHA senior director of policy, at 202-626-2365 or <a href="mailto:ademehin@aha.org">ademehin@aha.org</a>, or Caitlin Gillooley, AHA director of policy at 202-626-2267 or <a href="mailto:cgillooley@aha.org">cgillooley@aha.org</a> if you have further questions.</p> Wed, 13 Jul 2022 09:17:18 -0500 Star Ratings /news/headline/2022-02-11-cms-delays-hospital-star-ratings-update-until-july <p>The Centers for Medicare & Medicaid Services today announced it will delay updating the Overall Hospital Quality Star Ratings on the Care Compare website from April until July so it can correct a calculation error in the calendar year 2021 results for the OP-10 outpatient imaging efficiency measure. </p> <p>“As a result of this issue and a commitment to data accuracy, CMS will update the 2021 OP-10 measure results as well as the Overall Hospital Quality Star Ratings on Care Compare in July 2022 to correct the error and reflect the accurate results,” the agency said. </p> <p>CMS said no additional data or other actions from hospitals are required to recalculate the OP-10 measure, and that it does not expect the recalculation to impact CY 2022 payment determinations. Hospitals will be able to preview the updated overall star ratings and OP-10 measure results this spring in their facility-specific reports, the agency said. </p> <p>“To minimize stakeholder confusion, CMS is also delaying the public reporting of CY 2022 OP-10 measure results,” the agency said. “These measure results are for CY 2023 payment determination, and were initially scheduled for preview release in Spring 2022. CMS intends for the calculation error to be corrected in this and in future reporting of results for the OP-10 measure.” <br />  </p> Fri, 11 Feb 2022 15:07:33 -0600 Star Ratings