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Decoding Hospital Star Ratings

Created May 25 2017, 08:00 PM by Lippincott Solutions
  • Hospital Compare
  • Star Ratings
  • CMS
  • Center for Medicare Medicaid Services

Friday, May 26, 2017

How does your hospital measure up?

As part of the initiative to add Five-Star Quality Ratings for acute care facilities, the Centers for Medicare & Medicaid Services (CMS) publishes the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Star Ratings to the Hospital Compare web site.

Star Ratings are designed to make it easier for consumers to use the information on the CMS web sites and spotlight excellence in healthcare quality.

"These easy-to-understand star ratings are available online and empower people to compare and choose across various types of facilities from nursing homes to home health agencies," Dr. Kate Goodrich, director of the Center for Clinical Standards and Quality at CMS, wrote in a blog post announcing the star ratings' release.

How Hospitals are Scored

The methodology for the new Overall Hospital Quality Star Rating was developed with input from a technical expert panel and refined after public input. CMS continues to analyze the star rating data and consider public feedback to make enhancements to the scoring methodology as needed. The star ratings are updated quarterly, and incorporate new measures as they are publicly reported on the website as well as remove measures retired from the quality reporting programs.

The ratings are a composite metric of one to five stars, with five being the best. They intend to convey the overall quality of nearly 4,000 hospitals in the U.S. In grading hospitals on their overall quality, the CMS used 64 measures, such as hospital-acquired infection rates or emergency room wait times, that had already been posted to the Hospital Compare site. It grouped those measures into broader categories, then weighted them. Hospitals had to meet minimum reporting requirements in order to be eligible to receive a star rating.

Twelve HCAHPS Star Ratings appear on Hospital Compare: one for each of the 11 publicly reported HCAHPS measures, plus an HCAHPS Summary Star Rating. HCAHPS Star Ratings are applied to each of these 11 publicly reported HCAHPS measures, which are created from specific questions on the HCAHPS Survey, as noted:

HCAHPS Composite Measures

  1. Communication with Nurses (Q1, Q2, Q3)
  2. Communication with Doctors (Q5, Q6, Q7)
  3. Responsiveness of Hospital Staff (Q4, Q11)
  4. Pain Management (Q13, Q14)
  5. Communication about Medicines (Q16, Q17)
  6. Discharge Information (Q19, Q20)
  7. Care Transition (Q23, Q24, Q25)

HCAHPS Individual Items

  1. Cleanliness of Hospital Environment (Q8)
  2. Quietness of Hospital Environment (Q9)

HCAHPS Global Items

  1. Overall Hospital Rating (Q21)
  2. Recommend the Hospital (Q22)

Hospitals are only assessed on the measures for which they submit data. Some of the measures used to calculate the Overall Hospital Quality Star Rating are based only on data from Medicare beneficiaries and some are based on data from hospitals’ general patient population, regardless of payer.

For example, measures on deaths, readmissions, and use of medical imaging include data from Medicare beneficiaries only. The patient experience, safety, and timely and effective care measures include data from any adult patient treated at hospitals. Specialized and cutting edge care that certain hospitals provide, such as specialized cancer care, are not reflected in these quality ratings.

Making an Impact

In order to receive HCAHPS Star Ratings, hospitals must have at least 100 completed HCAHPS surveys over a given four quarter period. In addition, hospitals must be eligible for public reporting of HCAHPS measures. Hospitals with fewer than 100 completed HCAHPS surveys will not receive Star Ratings, but their HCAHPS measure scores will be publicly reported on Hospital Compare.

Over the past decade, CMS has published information about the quality of care across the five different health care settings that most families encounter. The new Overall Hospital Quality Star Rating summarizes data from existing quality measures publicly reported on Hospital Compare into a single star rating for each hospital, making it easier for consumers to compare hospitals and interpret complex quality information.

The Overall Hospital Quality Star Rating is designed to help individuals, their family members, and caregivers compare hospitals in an easily understandable way.

Check out the official Hospital Compare site here.