GeBBS Healthcare Blog

3 Ways Hospitals Can Improve Their CMS Star Rating (Regardless of its Flaws)

Posted on Fri, Mar 29, 2019 @ 08:14 AM

Lots of questions and headlines began swirling earlier this month after the Centers for Medicare and Medicaid Services (CMS) released its hospital star ratings – a “seemingly” simple system designed to help consumers make informed decisions about hospitals and the care they deliver.  While consumers are used to 5-star ratings for hotels and restaurants, the healthcare industry is clearly far more complex.  As such, a cloud of mystery and skepticism surrounds this incredibly powerful rating system – especially for the thousands of hospitals who participate in Medicare and are therefore automatically subject to stardom whether they like it or not.

Up to 60 quality metrics are combined to create this important rating – although hospitals often don’t know exactly which measures are included or how the measures are weighted – until after the ratings are released. While the star-rating system has been under attack for years by health systems claiming the system is flawed – the information can still help healthcare organizations make critical decisions about where to focus their efforts.

While consumerism has been slower to hit the healthcare market, it’s still having an impact as patients read headlines from hospitals boasting their 5-star ratings and wonder what rating their hospital of choice may have received.  With that said, what are you doing to ensure your hospital comes in with five stars next time around?

Regardless of your star rating or your agreement with the methodology that got you there – there are three things every hospital can do to help ensure the stars are in your favor.

  1. Benchmark Yourself Against Your Peers, Not Your Neighbors. It’s clear that the methodology used to determine CMS star ratings doesn’t favor larger systems with highly-acute, complex patients. That’s why hospitals shouldn’t necessarily compare themselves to their closest hospital competitors, but instead to like hospitals across the country. If you’re a large academic medical center, see how your star rating compares with hospitals that focus on similar service lines (i.e. cancer, cardiovascular care, etc.) and have approximately the same number of beds. Likewise, if you’re a small community hospital focused on elective orthopedic procedures, compare yourself to a similar organization in another market.  In either case, if your peers are performing better than you – dig into the data to see what you can do better.
  2. Chase Those Zeroes. “Safety of Care” was weighted at 22% for this year’s star rating criteria. Regardless of a hospital’s size, specialty or location, those with low hospital-acquired infection, preventable patient harm and readmission rates are going to perform better than those who struggle in these areas. Hospitals that focus on eliminating infections such as c. diff, CAUTIs, CLABSIs, patient falls with harm and readmission rates – will boast great scores on the PSI-90 composite metric – a leading measure used in determining a hospital’s star rating.  More importantly – as a hospital, focusing on eliminating preventable patient harm is the right thing to do no matter how you look at it.
  3. Focus on Patient Communication. Several measures related to how well nurses and physicians communicate with their patients have an impact on the overall patient experience. Hospitals that closely monitor their HCAHPS scores and use data to make improvements – may just see their star ratings improve, too. Whether it’s overall communication about a patient’s condition, procedure or hospital stay – or something more specific such as medications, discharge instructions, or transition of care, focusing on improving patient communication is sure to help your patients have a better experience. With the patient experience weighing in at 22% of this year’s overall star rating – it’s a worthy investment of your time and effort.
If you want to check hospital star ratings, visit Medicare.gov’s Hospital Compare web site.  If you have an opinion you’d like to share with CMS about star ratings – they are seeking public comment until March 29,2019

Tags: RCM Solutions