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CMS Releases Report on Improving Hospital Star Ratings

A new Centers for Medicare & Medicaid Service (CMS) report provides recommendations for improving usability of overall hospital star ratings that were shared during a Sept. 19 listening session.

The listening session, which engaged more than 300 in-person and virtual attendees, focused on:

  • the star ratings methodology, which CMS plans to update in 2020;
  • risk adjustment for social factors and peer grouping;
  • the ratings’ utility to patients and purchases; and
  • novel approaches for altering the ratings.

Participants urged the agency to consider how stakeholders use star ratings when deliberating how the ratings are calculated. CMS should balance patient needs with those of hospitals that might rely on star ratings to assess the effectiveness of quality improvement (QI) initiatives, participants said. Attendees also reported a lack of awareness of star ratings among patients and urged CMS to increase program outreach and improve website usability.

Listening session participants largely supported a CMS proposal to adjust for social risk factors based on dual eligibility for Medicare and Medicaid in the readmission measure group. Attendees also supported hospital peer grouping. One QI expert recommended peer grouping hospitals by type rather than number of measures reported, which would enable patients to look up quality hospitals for their specific conditions.

Additionally, participants reviewed CMS proposals for new ways to display and calculate star ratings, including user-customized star ratings, domain-specific star ratings, and ratings that incorporate improvement over time. While some participants supported customized ratings based on condition or procedure, others believed this would increase reporting burden.

Overall, stakeholders encouraged methodological changes to increase predictability and stability of star ratings and noted that more frequent updates would make ratings more relevant to patients.

The agency has convened a new technical expert panel and engaged with the provider leadership and patient/patient advocate work groups to continue seeking feedback. CMS will refresh star ratings with the current methodology in January 2020 and make public future methodology changes through the rule-making process.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.

About the Author

Emily Schweich is a communications manager at America's Essential Hospitals.

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