MARIA CASTELLUCCI August 19, 2019
The CMS announced Monday that it plans to change
the controversial methodology used for its hospital star ratings in early 2021.
The agency didn't disclose specific details
about what the changes will entail but it will propose them through public
rulemaking some time next year.
Plans to alter the methodology come six months
after the CMS issued a public input request seeking feedback on how the
ratings can be improved. The agency said it received more than 800 comments.
Although the changes won't come until 2021, the
CMS will still refresh the star ratings on Hospital Compare using the current
methodology in early 2020. The star ratings were last updated in February.
The American Hospital Association was disappointed
with the agency's decision to update the star ratings again before changes to
the methodology are made.
"While we appreciate that the CMS is
working on potential improvements to the rating methodology, we strongly
believe the CMS should not refresh the ratings until those improvements have
been vetted and are ready for implementation," said Ashley Thompson,
senior vice president of policy at the AHA. "Republishing the flawed
ratings in 2020 will not advance the goal of providing the public with accurate,
purposeful information about quality."
The CMS said it plans to use the feedback from
the public input request to guide its proposed changes to the star ratings. The
48-page public input request sought stakeholder feedback on nine potential
changes to the star ratings, the most significant of which was tossing out the
latent variable model used to assign hospitals ratings with an "explicit
approach" such as taking an average of measure scores.
Most commenters expressed issues with the latent
variable model and supported replacing it.
In their comments to the CMS, Dr. Stephen Evans,
chief medical officer of MedStar Health and Dr. Terry Fairbanks, vice president
of quality and safety at the system, called the latent variable model a
"black box" in nature.
"The latent variable model makes it very
difficult for hospitals to predict the impact of quality-improvement
activities," they said.
The latent variable model, which was created
with help from Yale New Haven Health as part of a multimillion-dollar contract
with the CMS, is a statistical approach that gives more emphasis to certain
measures over others in the star ratings based on a number of aspects,
including variation in performance among hospitals for that measure or how much
measures correlate to each other. This approach is why some measures have a far
greater influence than others in a hospital's overall rating.
Despite the controversy of the model, the CMS
will continue working with Yale New Haven Health on the star ratings. The
health system was awarded in April a $71.7 million contract for 10
months and some of the work includes re-evaluation of the star ratings. Lantana
Consulting Group is also contracting with the CMS on the star ratings and has a
$13.5 million contract.
The suggestion by the CMS in the public input
request to compare hospitals by type to determine star ratings elicited a mix
of responses. While many supported peer grouping hospitals, there were various
suggestions about how best to do it. Some wanted hospitals to be compared by
patients' socioeconomic status while others wanted the hospitals to be compared
by type such as teaching, specialty and community. Others didn't support the
idea at all, arguing it might lead to confusion for patients and encourage
hospitals to slack on quality improvement.
The majority of respondents didn't support
allowing consumers to customize the ratings based on their needs. The CMS
suggested in the public input request creating a tool that would enable
consumers to set their own weights for each of the measure groups used in the
star ratings. Those against the idea argued it would be too confusing for
consumers who don't have healthcare expertise. Some also said that not all the
measures used in the star ratings will be relevant to the consumer's condition
so it likely wouldn't be helpful to them.
Dr. Betty Chu, chief quality officer at Henry
Ford Health System, said patients would "end up with a blend of relevant
and irrelevant measures rather than a set of clearly relevant measures."
The change "maintains most of the problems
of the current system," she added.
A total of 24 hospitals, 35 health systems and
16 hospital associations participated in the public input request.
Along with the comments, the CMS will also form
a technical expert panel. The agency wants insight from hospital quality
leaders, statisticians, measurement developers, consumers and purchasers.
Applications for the panel are due Aug. 19.
Additionally, a listening session will be held on Sept. 19 to discuss
the comments from the public input request. The agency wants providers,
patients, patient advocates and quality measurement experts to attend.
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