A Note from the Associate Editorial Director: CMS quality rankings questioned

When it comes to providing high-quality patient care, most American hospitals simply don’t. That’s if the recent round of five-star rankings from CMS are to be believed. About 1,700 hospitals (39%) earned just three out of five stars, an “average” rating, FierceHealthcare reported.

The rankings, updated quarterly on Hospital Compare, apply to more than 3,500 hospitals. Hospital Compare allows consumers to select multiple hospitals and directly compare performance measure information related to heart attack, heart failure, pneumonia, surgical complications, asthma, readmission rates, and other conditions, according to the CMS website.

The rankings take into account 64 of 100 total measures, and facilities are only assessed for those measures they submitted data about.

“The Overall Hospital Quality Star Rating reflects comprehensive quality information about the care provided at our nation’s hospitals,” wrote Kate Goodrich, MD, MHS, Director of Center for Clinical Standards and Quality for CMS on its blog.

But many facilities that treat low-income populations, such as teaching and “safety-net” hospitals say the ranking unfairly paints their programs, according to a Kaiser Health News article published on NPR. And Medscape reported that teaching hospitals had an average ranking of 2.87 compared with 3.11 for nonteaching hospitals while safety-net hospitals had a mean rating of 2.88 compared with 3.09 for nonsafety-net hospitals.

Of the 102 hospitals that earned a five-star ranking, few hailed from among those commonly held in high regard. Memorial Hermann Hospital System in Houston and Mayo Clinic in Rochester, Minnesota, for example, each got five stars, according to the NPR report, but Beth Israel Medical Center in Manhattan, Barnes-Jewish Hospital in St. Louis, and Tufts Medical Center in Boston each only earned two stars.

It’s true that statistical analysis of varying data points shifts quality rankings significantly. As the NPR article points out, only a few of the facilities which private ratings sources such as U.S. News & World Report, ranked as top-notch made the Hospital Compare five-star rankings. And yet, the U.S. News & World Report’s rankings came under fire as well in the not-so-distant past. So have other private-party rating systems such as LeapFrog and HealthGrades.

In the May edition of the Journal of the American Medical Association (JAMA), authors called on CMS to “define standards of what makes a good measure and set accuracy requirements before implementing measures in pay for performance and public reporting.”

Goodrich calls the CMS data valid. All of the measures used to calculate the rating are “based on clinical guidelines and have undergone a rigorous scientific review and testing,” she wrote. Furthermore, the majority of the measures were endorsed by the National Quality Forum and were adjusted for clinical co-morbidities to account for the illness-burden of the population, Goodrich says.

Once upon a time we just trusted our doctors, our nurses, our local hospital down the street to abide by the Hippocratic oath and do what’s best in the interest of their patients. And for the most part they do. But remember what they call the medical school graduate who got the lowest grades in the class? That’s right, a doctor.

In May, a study by researchers at Johns Hopkins Medicine suggested that medical errors should rank as the third leading cause of death in the United States — and highlighted how shortcomings in tracking vital statistics may hinder research and keep the problem out of the public eye.

Just as consumers need to examine these various reports to make the best decisions for their medical care, CDI specialists should be reviewing them to identify what areas of the grading schematics may benefit from better documentation. They should show physicians their rankings and help administrators understand how CDI efforts can help clear up the data, improve reporting, and show the world what high-class care is actually being provided.

Editor’s Note: ACDIS members can click here to view a complete list of quality measures that affect CDI.