CMS Star Ratings System Flawed

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Jill Chadwick

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            Five-stars may be a good way to rate a hotel room or appliance, but experts say it’s not a way for the federal government to measure healthcare quality or safety.  The Centers for Medicare and Medicaid Services(CMS) Five-Star Quality Ratings system is coming under fire again with the release of its most recent rankings.  The Five-Star Quality Ratings is considered seriously flawed by The American Hospital Association(AHA), The Association of American Medical Colleges(AAMC), as well as academic hospitals including The University of Kansas Hospital. 

 “The rating system is not an apples-to-apples comparison, the data is two years old and unfairly penalizes teaching and other hospitals that serve higher numbers of the poor,” Tim Williamson, MD, vice president of Quality and Safety at The University of Kansas Hospital said. “The use of a star system implies substantial differences in quality may exist across hospitals when it does not.  Using it to rank safety and quality is like driving a semi using the rear-view mirror.”

 Critics say assigning a ‘magic’ number of stars implies that hospitals have been measured on an equal basis and that comparisons are fair, but that is not the case. 

            “Community hospitals serve a critical role in community healthcare, while teaching hospitals perform a wider array of complex procedures among the sickest of sick,” Dr. Williamson explained.

CMS’ Star Ratings lumps all hospitals together in a report that uses more than 60 metrics to measure academic hospitals compared to only nine measures applied to other hospitals that treat less sick patients. The hospitals with the higher five-star ratings actually had the lower measured metrics.

Critics worry the ratings can mislead patients by steering them away from some of the best hospitals for treatment of their conditions.  “Academic hospitals measure quality and safety all the time,” Dr. Williamson said.  “The University of Kansas Hospital’s safety performance in one metric that looks at a combination of safety issues currently ranks 6th out of 138 academic hospitals for the past year in tracking of safety metrics by University HealthSystem Consortium(UHC).”

 In the interview that follows, Dr. Williamson explains in more detail the flaws of the CMS Five-Star Ratings, what consumers need to know before using the ratings system and how The University of Kansas Hospital tracks safety and quality.