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NQF Panel Urges Transparency, Clarity in Hospital Star Ratings

A new National Quality Forum brief calls on the Centers for Medicare & Medicaid Services (CMS) to be more clear about the intent and goals of the hospital star rating program and more transparent about what star ratings convey, and to present data in a way that meets consumer priorities.

The brief summarizes recommendations and considerations from an expert panel convened at an August summit, which included America’s Essential Hospitals staff. Participants shared ideas to strengthen the CMS overall hospital quality star ratings system, which will use a new methodology starting in 2021.

While star ratings initially were developed to summarize Hospital Compare quality measures in a consumer-friendly way, they increasingly are used as a measure of overall hospital quality. Panelists urged CMS to communicate more clearly the purpose of the program and the quality construct that it seeks to measure.

Additionally, panelists suggested making measure groups more clinically cohesive and expanding ratings beyond a summary of Hospital Compare measures to include additional specialties and services.

Notably, the panel discussed risk adjustment for sociodemographic factors, as the ratings program does not employ such adjustment at the measure group (i.e.,domain) or star levels. Members acknowledged that applying risk adjustment at the domain or overall star rating level is not always justifiable, but they agreed that social risk adjustment should be considered at the measure level and in the adoption of new measures. The panel noted that CMS also should consider approaches to peer grouping that are most meaningful to patients for example, location, hospital characteristics, or service lines.

The panel also discussed expanding data sources beyond Medicare fee-for-service beneficiaries to capture the full population served by a hospital.

A CMS technical expert panel will consider these recommendations as part of the agency’s ongoing efforts to re-evaluate the star ratings program. CMS plans to address modifications to the star ratings in 2020 rulemaking, and will refresh the ratings using the new methodology in early 2021.

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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