Cooperating for better care.


Tag Archives

Here’s the latest in CMS’s hospital-rating saga



For Kaiser Health News

Over the past decade, the federal government has publicized 115 different ways to measure medical quality in hospitals, from assessing wait times in emergency rooms and noise levels outside hospital rooms to tracking blood clots in surgical patients. But the latest effort, to combine dozens of metrics into one patient-friendly quality indicator, has proven the most contentious.

The Centers for Medicare & Medicaid Services recently postponed its plan to release the new rating system, which would award one star to the worst-quality facilities and five stars to those with the best marks. The delay came after a majority of members of Congress signed a letter supporting the hospital industry’s concerns.

Hospital leaders who previewed the preliminary rating system say that the formula seems skewed against institutions that treat the poorest or toughest patients, meaning those with complex illnesses. The number of stars would be based on 64 different measures, which are posted on Medicare’s Hospital Compare Web site. The metrics on mortality, readmission, patient experience and patient safety are the most influential, each representing 22 percent of a facility’s rating.

Steven Lipstein, president of BJC HealthCare, a St. Louis-based nonprofit that runs 14 hospitals, said the ones in his organization that earned five stars were smaller, located in affluent areas and handled less complicated cases. “They don’t have comprehensive cancer centers, they don’t have major cardiovascular disease, they don’t have neuro-specialties,” he said.

BJC’s more advanced hospitals did worse, he said. “That’s not surprising when you look inside the ratings and see how they’re built,” he added.

Consumer advocates defend the rating system, saying that while not perfect, it correctly reflects higher rates of problems in some big institutions despite their lofty reputations. They worry that delay and congressional resistance are undermining Medicare’s attempt to help consumers select a hospital based on something more substantive.

“The star ratings hopefully will get quality into that decision-making process,” said Andrew Scholnick, a lobbyist for AARP, the advocacy group for seniors.

Medicare officials initially said they hoped to release the ratings to the public in July. But in a presentation to hospitals and other interested parties on May  12, they did not set a firm date.

Medicare already has made minor tweaks in the formula to calculate the stars, but it remains a tough grader, the presentation shows. If Medicare releases the star ratings in July, nearly half of the 3,658 hospitals being evaluated would be getting three stars, according to Medicare’s preliminary calculations. Just 100 hospitals would receive five stars, while 135 would receive a single star.

Officials indicated they were standing firm in their intention to eventually release the scores. “The Overall Star Rating represents a performance summary designed to facilitate patient and consumer use of Hospital Compare,” the presentation said. Officials plan to update the scores every three months through the end of this year and then twice thereafter.

The broader debate about the government judging hospitals has been going on since Medicare began publishing quality ratings in 2005. But it has intensified since passage of the Affordable Care Act, which instructed Medicare to use quality metrics in setting payments.

Teaching hospitals as a group have tended to fare poorly from some of these financial incentives. This year, for instance, nearly half of major teaching hospitals are losing 1 percent of their Medicare payments because of high rates of infections and surgical complications. Facilities with more low-income patients, who often face difficulties affording medication, following complicated recovery instructions and getting to doctors regularly, typically have higher readmission rates.

Some health care researchers are also skeptical. “If you come out with a rating that says Cleveland Clinic is terrible but podunk hospital in North Carolina, they’re the bomb, there’s a disconnect,” said Ashish K. Jha, a professor at Harvard’s public health school. “If it completely contradicts everything you’ve known, you need to ask yourself, ‘Did I not understand the way hospital care works, or is there a problem with the metric?’”

Medicare’s move toward using star ratings is part of a greater focus on easy-to-grasp composite judgments of hospital quality. The Leapfrog Group, a nonprofit patient-safety group, uses report-card letter grades to characterize hospital safety based on many of the same individual measures as Medicare. Healthgrades, a Denver-based company, judges hospital quality with one, three or five stars. Consumer Reports calculates a safety score on a 100-point scale.

Medicare hopes that a star rating from the government will carry even more credibility.

“People need this information now,” Scholnick said. “Trying to wait until everyone’s 100 percent happy with everything just delays it further than it needs to be.”

UnitedHealthcare publishing physicians’ patient-satisfaction scores


Will he get an “A”?

Patients can now see physicians’ patient-satisfaction scores,  as compiled by Healthgrades, on the Web site of UnitedHealthcare, the nation’s largest private-sector health insurer.

Each physician profile includes a rating on a five-star scale for the likelihood of recommending the physician.

Medscape says that many physicians won’t like this, of course, but UnitedHealthcare and Healthgrades “offer assurances that the ratings are meaningful and mostly positive, and that much-criticized methodological weaknesses are not as damning as they are made out to be.”

More hospitals post online physician reviews


“The Polling (1755),” by William Hogarth.

Rush University Medical Center, in Chicago, has become the first organization in the Midwest to post the results of patient surveys in the profiles of individual physicians on its Web site.

This come  a few weeks after word that Long Island-based North Shore-LIJ Medical Group also plans to post patient reviews of its physicians online. FierceHealthcare said that made it the first large medical group in the New York City metropolitan area to do so.

Many providers, presumably  seeking more control over their public relations, now share patient-satisfaction surveys with the general public instead of relying on such outside popular rankings sites as Healthgrades, Vitals or rateMDs.


Guidance on using health technology


Roger Holstein, the chief executive of Healthgrades, a Web site that rates and provides information on physicians, dentists and hospitals, advises consumers, (and by implication, providers) about using technology in the brave new world of health technology.

He  tells The St. Louis Post Dispatch that says consumers can ensure better health outcomes by applying the same research to their medical providers as for life’s other decisions.


He discusses:

How to  connect people to the right physicians

How to  educate patients about their physicians and the health system as a whole.

The  role of transparency and data in healthcare.

The future of buying health insurance.

Dealing with the narrowing of provider networks.



Contact Info

(617) 230-4965

Wellesley, Mass