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CMS delays October star ratings release as advocacy groups push for major methodology overhaul

Star ratings released last December will remain on the Hospital Compare website until the next update, CMS said.

Beth Jones Sanborn, Managing Editor

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The Centers for Medicare and Medicaid Services has once again delayed the release of updated overall hospital quality star ratings on Hospital Compare, announcing Wednesday that there will be no October update.

According to a post by the American Hospital Association, CMS was quoted as saying they decided not to proceed with the October update "to continue its examination of potential changes to the Star Rating methodology based on public feedback."

[Also: Hospitals get time to preview star ratings, CMS says]

The star ratings released last December will remain on the Hospital Compare website until the next update, CMS said. The ratings were scheduled to be updated in July, after a one-year delay from the original launch date of April 2016 was pushed to July 2016.

The AHA has urged CMS to remove the overall star ratings from Hospital Compare and look at other methods of rating. While they have expressed appreciation for the agency taking feedback, they expressed concern over proposed changes to the ratings, saying they would address only some of the issues.

[Also: Hospital star ratings skew lower in Michigan's impoverished areas, report says]

"However, CMS's own analysis shows that nearly 700 hospitals would experience a change in their star ratings, amplifying our concern about the reliability and accuracy of the chosen methodology," wrote Ashley Thompson, AHA senior vice president of public policy analysis and development.

Thompson penned a letter to CMS this week, urging several major changes to how the scores are formulated including the inclusion of "negative factor loading" from the scores, which the AHA said has the opposite effect of what intended. The methodology includes measures with this type of loading which carries an inverse relationship to the performance score. If a hospital performed well against other hospitals on that measure, the score is actually negatively impacted, whereas if the hospital performed poorly on that measure compared to others, their score goes up.

The AHA is also pushing for a different approach to weighting the measure groups, saying CMS should poll patients and families for a sampling of views about how to weight the measure groups.

"At a minimum, AHA strongly urges CMS to remove the star ratings from Hospital Compare and not republish them until it corrects the errors and outside experts agree that the updated methodology is executed correctly."

It's not just the AHA who is blasting the ratings' accuracy and overall worth to consumers. After last July's release, Health Affairs also called the agency's scoring methodology flawed, and said it "would no more harm than good" for patients.

They said CMS calculated and published star ratings for hospitals that did not have enough data to report on all domains, reporting that some had only enough data to support reporting on one domain. When a hospital lacks sufficient data to report on one or more quality domains, the "weights" of the missing domains are redistributed to the domains that have enough data to be measured.

"The fewer the clinical outcome domains a hospital reports, the less that hospital's overall star rating is actually tied to performance on patient outcomes," Health Affairs said.

Twitter: @BethJSanborn
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