Hospital Star Ratings - A Game Changer?

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

On July 27th, 2016, CMS finally released the long awaited star ratings of hospitals in the United States by announcing “today, we are updating the star ratings on the Hospital Compare website to help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side-by-side, and ask important questions about care quality when visiting a hospital or other health care provider. ” Local news sites have been quick to tout the ratings of high performers and question the performance of any hospital with less than 3 stars. The ratings are a composite metric of one to five stars, with five being the best and were assigned to 3,617 hospitals across the United States. Obviously it has its critics. Some industry stakeholders have questioned the precision and accuracy of the metrics and the adequacy of CMS’ methodology. They have called for better risk-adjustment so that hospitals treating disproportionate numbers of poor or uninsured patients, who have less access to healthcare in their communities once they leave the hospital, aren’t penalized.

What is being Measured?

The overall rating includes 64 of the more than 100 measures reported on Hospital Compare, divided into seven measure groups or categories: mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging. Not every hospital has been given a star rating – only about 80%. In order for Hospital Compare to display an overall rating for a hospital, the hospital must have enough data on the individual quality measures used to calculate the overall rating. Some of the measures used to calculate the overall rating are based only on data from Medicare patients and some are based on data from all patients. For example, measures on deaths, readmissions, and use of medical imaging include data from Medicare patients only. The patient experience, safety, and timely and effective care measures include data from any adult patient treated at hospitals.

Some hospitals, due to the number and type of patients they treat, may not report data on all measures, and therefore, are not eligible for an overall star rating. For example, hospitals that are new or small may not have enough patients for the measures used to calculate an overall rating. Ratings range from 5 start indicating outstanding performance to 1 star which would be below average. Most hospitals in the US received 3 stars.

The Rise of Rateocracy

With the rise of the internet, consumers have now been empowered to rate products, endorse services and post complaints in forums that are widely viewed such as on Amazon, Tripadvisor, eBay, Yelp and Angie’s list. Job hunters and employees can read and rate their employers on sites such as Glassdoor.com. On Facebook, users can endorse a product or person by “liking” it and on LinkedIn, your skill in certain areas can be endorsed by others. These are ratings are real time and have led companies and their leaders to be very concerned about their online “reputation management”. Consumers have come to value knowing how many “stars” or likes a product or service receives. According to Moran and Carfi, these trends are just in their infancy stages. They see the trend toward Rateocracy as a game changer for both organizations and their leaders. At this point, they acknowledge that on many of these sites, there are not enough comments or ratings to be statistically robust. Over time with more users, this hospital compare care data could become much more representative and trusted.

Implications for Nurse Leaders

Most nurse leaders are probably not yet in the habit of having to explain to consumers why your hospital has the ranking that it does. We don’t know yet what the impact could be on consumer use of a hospital. It is humbling to read bad reviews or less than three stars but the key is to examine trends. As nurse leaders, this could force us to become much more transparent in our practices, better listeners and stronger communicators.

Moran, R. (2012) Rateocracy and Corporate Reputation. World Futurist. May-June 2012.

Whitman, E. (July 27th, 2016) CMS releases star ratings for hospitals. Modern Healthcare