The AAMC July 7 joined with the American Hospital Association (AHA), America’s Essential Hospitals, and the Federation of American Hospitals in a letter to the Centers for Medicare and Medicaid Services (CMS) expressing serious concern regarding the lack of feedback on requests for information and urging CMS to address several significant methodological problems with the star ratings. In the letter, the associations request that the ratings be delayed until these issues are addressed.
The hospital association letter notes that they repeatedly requested that CMS analyze the star ratings on different types of hospitals, consider a sociodemographic adjustment for readmissions and other outcome measures, and examine whether certain measures (such as the PSI-90 composite or the hospital-wide readmissions) disproportionately disadvantage any particular type of hospitals.
The associations state that “virtually no additional information [was received] from CMS on any of the issues listed above. The agency provided additional information on how it calculates and assigns star ratings, but far too little information on whether the methodology gives a fair and accurate appraisal of the true quality of care provided in America’s hospitals.” The letter also cites concerns that the Agency’s actions do not “meet the intent of what Congress urged CMS to do nor what CMS told Congress it would do.”
Finally, the letter highlights methodological concerns raised by Dr. Frank Vella, chair of economics at Georgetown University. Dr. Vella noted the following flaws with CMS’s current model for determining star ratings:
- Arbitrary methodologic choices made by CMS which may have a substantial impact on hospital star ratings;
- The model fails to account for other factors that may cause substantial variation in performance, and instead attributes the variation solely to quality;
- The assignment of star ratings implies that hospitals have been measured on essentially an equal, or at least an equivalent, basis. This is not the case given that a significant number of hospitals do not have a sufficient number of cases to be evaluated on some of the quality domains; and
- Ranking the hospitals by stars is misleading as it indicates a substantial change of quality performance (e.g., from 5 stars to 4 stars) that may be more reflective of the rating methodology than actual quality differences
The star ratings may be posted on the Hospital Compare website as early as July 21, 2016.