
Quality Improvement
America’s Essential Hospitals and its members are committed to improving quality by reducing hospital-acquired conditions (HACs) that create serious adverse outcomes for patients and lowering the number of preventable readmissions. Essential hospitals are at the forefront of using evidence-based guidelines to prevent HACs and improve the overall patient experience.
National efforts to track hospital quality include public reporting of quality rating information and use of performance measures to link quality to payment. In that context, it becomes critically important to measure outcomes and align measures across care settings.
Our Members’ Performance on Selected Process of Care Measures

Source: 2014 Essential Data: Our Hospitals, Our Patients — Results of America’s Essential Hospitals 2014 Annual Member Characteristics Survey.
But measures often fail to account for social and economic challenges vulnerable patients face and that a hospital has little or no ability to control. Without risk adjusting measures for these socioeconomic factors, quality incentive programs disproportionately penalize essential hospitals, which already operate with a zero margin, on average. This creates a vicious circle in which quality erodes further because hospitals lose the very funding they need for improvements.
America’s Essential Hospitals advocates for quality improvement program measures that are properly constructed, risk adjusted for factors beyond the control of the hospital, and that do not lead to unintended consequences for, and administrative burdens on, essential hospitals.
CMS Releases July 2022 Overall Hospital Star Ratings
Aug. 2, 2022 ||This is the second star ratings update since the agency updated its methodology in 2020 to include the use of peer grouping.
view more »CY 2023 OPPS Rule Includes 340B, Site-Neutral, and Quality Proposals
July 25, 2022 ||A proposed rule for Medicare’s Outpatient Prospective Payment System for calendar year 2023 would reverse Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program, continue site-neutral payment policies, and revise the inpatient-only list, among other proposed changes.
view more »CY 2023 PFS Proposed Rule Released
July 19, 2022 ||A proposed rule for the Medicare Physician Fee Schedule for calendar year 2023 would extend telehealth regulatory flexibility, make changes to the Medicare Shared Savings Program, and revise the Quality Payment Program.
view more »NSC Urges Commitment to Patient and Workforce Safety
June 13, 2022 ||The National Steering Committee for Patient Safety calls on health care providers to put its 2020 Action Plan into practice.
view more »July 2022 Hospital Overall Star Ratings Preview Reports Available
June 7, 2022 ||Hospitals have until June 16 to preview their Overall Hospital Quality Star Rating, measure group score, and individual measure results, along with peer grouping.
view more »2023 Marketplace Benefit and Payment Parameters Finalized
May 3, 2022 ||The final rule raises the essential community provider threshold from 20 to 35 percent and uses wait time standards to evaluate qualified health plans for network adequacy.
view more »CMS Delays Hospital Star Ratings Update Until July
Feb. 15, 2022 ||Due to a calculation error in measure results used for calendar year 2021 public reporting, the Centers for Medicare & Medicaid Services has delayed until July the overall hospital star ratings update originally scheduled for April.
view more »HHS Awards $103M to Reduce Provider Burnout, Support Mental Health
Jan. 24, 2022 ||HHS awarded $103 million to improve health care worker retention by reducing staff burnout and promoting mental wellness. Several essential hospitals were among the awardees, including the University of New Mexico, Virginia Commonwealth University, and the University of Utah.
view more »Association Comments on Notice of Benefit and Payment Parameters
Jan. 24, 2022 ||In response to the proposed rule for the 2023 plan year, the association urged the Department of Health and Human Services to ensure equitable access, finalize nondiscrimination policies, standardize collection of Z codes, and prorate premiums and advanced premium tax credits.
view more »Biden Administration Issues Call to Action on Maternal Health
Dec. 7, 2021 ||Vice President Kamala Harris hosted the first federal Maternal Health Day of Action. Coinciding with the event, America’s Essential Hospitals announced 12 member hospitals will participate in a new CVS Health Foundation–funded learning collaborative to improve maternal health.
view more »Details of CY 2022 OPPS, PFS Final Rules
Nov. 18, 2021 ||Final rules for Medicare’s OPPS and PFS for CY 2022 continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program; continue site-neutral payment policies; and halt elimination of the inpatient-only (IPO) list.
view more »CMS Issues FY 2022 IPPS Final Rule
Aug. 20, 2021 ||The rule includes numerous policy and payment changes for Medicare’s Inpatient Prospective Payment System for fiscal year 2022, including a 2.5 percent increase in inpatient payment rates.
view more »Overall Hospital Star Ratings Updated on Care Compare
May 3, 2021 ||The Centers for Medicare & Medicaid Services published updated overall hospital quality star ratings on its Care Compare website; the ratings were last updated in January 2020. America’s Essential Hospitals has expressed continued concern about the fairness and reliability of the ratings.
view more »CMS Releases Hospital Star Rating April Preview Reports
Feb. 2, 2021 ||Hospitals have 30 days to review their reports before public reporting to Care Compare.
view more »CMS Proposes to Streamline Prior Authorization, Patient Access to Data
Jan. 5, 2021 ||The proposed rule builds on a CMS final rule on interoperability and patient access; it would leverage application programming interfaces to improve patients’ access to their electronic health information and reduce burden on providers related to prior authorization.
view more »CMS Launches Next Phase of Maternal, Infant Health Initiative
Jan. 5, 2021 ||The next phase of the Maternal and Infant Health Initiative (MIHI) includes a new focus on postpartum care visits, well-child visits, and decreasing rates of cesarean-section births in low-risk pregnancies. A work group developed a set of recommendations and a report on next steps for the MIHI.
view more »CY 2021 OPPS, PFS Rules Include 340B, Site-Neutral, and Star Rating Policies
Dec. 18, 2020 ||Final rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule for calendar year 2021 continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program and site-neutral payment policies.
view more »Maternal Health Action Plan, Call to Action
Dec. 8, 2020 ||The Department of Health and Human Services released a detailed action plan on maternal health and announced a public-private partnership to reduce maternal mortality and morbidity. The surgeon general simultaneously announced a call to action to improve maternal health, complementing HHS’ plan.
view more »CMS Retires Hospital Compare; No Star Ratings Update in Jan.
Nov. 20, 2020 ||The Centers for Medicare & Medicaid Services (CMS) on Dec. 1 will retire its original Hospital Compare tools, encouraging users to visit Medicare.gov’s new Care Compare tool to find and compare health care providers. CMS will not update the overall hospital quality star ratings in January 2021.
view more »NQF Guidance: Designing Measure Sets and Systems
Aug. 11, 2020 ||A new report, from a National Quality Forum (NQF) 25-person technical expert panel, provides insight on how quality measures can be combined in a system to improve health outcomes and drive high-value care for all.
view more »CMS Issues Proposed IPPS Rule for FY 2021
May 18, 2020 ||The proposed rule would increase inpatient payment rates by 3.1 percent, reduce Medicare disproportionate share hospital payments by about $0.9 billion compared with fiscal year 2020, and collect median third-party charge data on Medicare cost reports.
view more »Quality Program Reporting Exemptions, COVID-19 Testing Guidance
March 31, 2020 ||CMS releases guidance for hospitals in quality reporting programs; CDC updates guidelines for testing and handling COVID-19 specimens.
view more »On the Hill: COVID-19 Response, Star Ratings Letter
March 10, 2020 ||Both chambers passed a bill providing more than $8 billion to combat the new coronavirus; House leaders now are discussing legislation to mitigate economic impacts associated with the virus. A Senate letter calling to incorporate social determinants into hospital star ratings closes tomorrow.
view more »On the Hill: Budget Hearings, Star Ratings Letter
Feb. 25, 2020 ||HHS Secretary Alex Azar will discuss the president’s proposed fiscal year 2021 budget at several congressional hearings. A bipartisan Senate letter calls for incorporating social determinants into star ratings. A new association work group focuses on the Medicaid Fiscal Accountability Regulation.
view more »CMS Plans to Combine Quality Compare Tools
Jan. 31, 2020 ||CMS plans to transition to a unified Medicare Care Compare portal this spring that will combine and standardize the eight existing tools and allow a single point of entry for quality information.
view more »Quality Data, Hospital Star Ratings Refreshed
Jan. 31, 2020 ||This month’s data refresh is based on the existing, flawed methodology used during the last update of star ratings in February 2019.
view more »CMS Updates Interpretive Guidance for Surveyors
Jan. 7, 2020 ||The new guidelines reflect revised conditions of participation in the September 2019 discharge planning and burden reduction final rules.
view more »CMS Releases Report on Improving Hospital Star Ratings
Dec. 17, 2019 ||The report is based on feedback gathered during a September listening session, in which more than 300 stakeholders shared recommendations for improving predictability, stability, and relevance of star ratings.
view more »States Tackle Substance Use Disorder in Pregnant Women
Nov. 25, 2019 ||States are leveraging financial incentives, quality measures, waivers, and public-private partnerships to slow climbing rates of substance use disorder and overdose among pregnant women.
view more »Association Comments on Part 2 Proposed Rule
Oct. 25, 2019 ||The association expressed support for the Substance Abuse and Mental Health Services Administration’s proposed revisions to confidentiality of records for patients with substance use disorders, while outlining remaining barriers to care coordination.
view more »CMS Awards Planning Grants for Substance Use Disorder Treatment
Sept. 24, 2019 ||The 18-month grants, awarded to 15 state Medicaid agencies, seek to increase the ability of providers to deliver substance use disorder treatment and recovery services.
view more »Rating the Raters Initiative Evaluates Hospital Quality Rating Systems
Aug. 20, 2019 ||An NEJM Catalyst article assesses four public hospital quality reporting programs’ ability to classify hospital performance.
view more »CMS Announces Star Ratings Listening Session, 2020 Data Refresh
Aug. 19, 2019 ||The agency plans to update the Overall Hospital Quality Star Ratings methodology in 2021 and will host a Sept. 19 listening session to seek stakeholder feedback.
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