Under Pressure, CMS Delays Hospital Quality Ratings Release

The American Hospital Association is among those asking for a rating system that reflects socioeconomic differences in hospital populations.

CMS announced Wednesday that a new set of hospital quality ratings, designed to help consumers decide where to get healthcare, would be held until July while the federal officials work with stakeholders on issues of methodology and fairness.

Hospitals and members of Congress had put significant pressure on CMS in recent weeks, prompting the email to both groups that ratings would not be released today on the Medicare Hospital Compare website. Letters sent to CMS Acting Administrator Andy Slavitt seeking the delay were signed by 60 US senators and 200 members of the House of Representatives.

In particular, hospitals take issue with CMS’ failure to account for differences in quality ratings that might result from who shows up for care. The American Hospital Association (AHA) has said that quality ratings should be adjusted to factor in how many low-income patients a hospitals treats, or how many have multiple chronic conditions. The ratings set for release do not do this.

CMS’ critics say any rating system that fails to account for socioeconomic factors will end up punishing urban hospitals, and academic teaching hospitals in particular, which could steer Medicare funds away from the facilities that most need federal dollars.

Ashley Thompson, AHA’s acting senior executive for policy, discussed the delay in a blog post Wednesday. “We … support the majority of CMS’ principles for creating a start rating system and are glad to assist in thinking through how to overcome many of the impediments to successfully creating such a system,” she wrote.

As far back as September 2015, the AHA said CMS should start fresh with a “star rating” system aimed at the public, “rather than trying to retrofit existing Hospital Compare measures when they were not chosen with this goal in mind.”

At that time, the industry group said in a letter to CMS Deputy Administrator Patrick Conway, MD, that it supported the concept of hospital ratings to guide consumers, but wanted one ground in consistency, scientific rigor, inclusivity, and accessibility—and one that reflected stakeholder input.

The AHA urged CMS to reconsider readmission rates and mortality measures, as these would “likely lead to misclassification of hospitals, resulting in misinformation for patients.” The 30-day readmission rate has emerged as a key quality indicator as reimbursement moves away from fee-for-service to value-based care.

Socioeconomic status is likely to get more attention during this delay. A 2014 study from Truven Health Analytics found that for 2011 and 2012, found that 12% of excess hospital readmissions were attributable to race, employment status, and education, with being unemployed the biggest predictor of readmission.

A study examining hospital quality and outcomes after myocardial infarction, presented at the 2015 meeting of the American College of Cardiology (ACC), found that hospitals in low-income areas were just as likely—or more so—to follow ACC quality standards as those in wealthier areas. But the hospitals serving the poor might have worse outcomes overall, because the patients arrived with higher rates of diabetes, obesity or smoking.