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CMS Declines to Update 2018 Hospital Quality Star Ratings

Published on August 07, 2018 by Graham Newnum

LEP Patients CMS Hospital Ratings Update

The Center for Medicare and Medicaid Services (CMS) has forgone the scheduled midyear update to their CMS Hospital Quality Star Rating formula. The agency had an updated model ready to debut in June but pulled it preemptively when hospitals realized – after receiving a preview version in May - that it might shift some hospitals’ ratings by a full two stars compared to the previous formula.

These rating shifts appeared likely to depend on factors outside hospitals’ direct control. Research shows that the existing CMS formula appears to favor specialty hospitals (61% of which received five stars) over teaching hospitals (of which less than 10% scored a five-star rating). Sullivan Cotter’s Dr. Mark Rumans sees that not as an indication of varying quality, but of the differing types of cases seen at teaching vs specialty hospitals.

"If you end up at a major teaching hospital you are really sick,” Rumans explained. “You are seeing multiple specialists, your length of stay is long…Compare that to the experience at a specialty hospital, which has lengths of stay of one or two days. Those are such different levels of experience."

Rather than roll out the slated update which was expected to worsen these disparities, CMS plans to convene a panel of experts this summer. Their goal: to solicit feedback and examine ways to make sure Star Ratings are in line with the quality experienced by actual patients. Any output from the panel should be incorporated into the next iteration of the Ratings system, current scheduled for a December 2018 release.

While the exact formula for calculating CMS Hospital Star Ratings is largely out of the hands of any specific hospital, the inputs can be improved – metrics like Patient Mortality and Safety, Readmission Rates, and Patient Experience/HCAHPS Scores. These metrics can easily dip when treating limited-English proficient (LEP) patients. Here’s how a language barrier impacts each, and how using qualified, professional interpreters – whether on-staff or via phone or video through CyraCom – can help:

1. Mortality/Safety of Care– 44% of a Hospital’s Overall Rating

The Journal for Healthcare Quality studied the disparity in outcomes between English-speaking and LEP patients. They concluded that adverse events for LEP patients are often caused by hospital staff failing to use an interpreter. Hospitals can improve their staff’s utilization of interpreters by:

- Enlisting hospital executive support to make the use of qualified interpreters a top-down priority.

- Implementing consistent, recurring training on the “why” and “how” of using interpreters.

- Partnering with a language services provider whose user experience is straightforward, streamlined, and effective.

2. Readmission Rates– 22% of a Hospital’s Overall Rating

Statistically, non-English speakers, particularly in Latino and Chinese populations, readmit at a significantly higher rate than the general population. A review of 10.7 million Medicare patient records revealed that avoidable readmissions cost Medicare $17 billion a year because patients do not:

- Understand their diagnosis

- Know which medication to take and when

- Comprehend important information or test results

- Schedule a follow-up appointment

- Receive adequate home care

Hospitals committed to reducing readmission rates among their LEP patient populations can make interpreters part of their continuum of care at each stage of treatment:

Admissions - Interpreters expedite the check-in process and puts LEP patients at ease

Consent - Doctors can obtain patient informed consent via interpreter pre-procedure

Rounds - Nursing staff can use in-room remote interpretation to check on LEP patients

Discharge - Have aftercare instructions translated into the patient’s preferred language

Post-Discharge - Use an interpreter for follow-up calls and physician visits

3. Patient Experience/HCAHPS– 22% of a Hospital’s Overall Rating

LEP patients tend to rate hospitals worse than English-speaking patients due to negative experiences during treatment. The National Center for Biotechnology Information (NCBI) found that LEP patients are:

- 9x more likely to have trouble understanding medical scenarios

- 4x more likely to misunderstand medication labels

- 4x more likely to have a bad reaction to medication

Offering high-quality language access to LEP patients may succeed at improving satisfaction and HCAHPS scores where basic compliance has failed. NCBI analyzed over 19,000 HCAHPS surveys from 66 California hospitals and learned that:

“Hospitals with greater cultural competency have better HCAHPS scores for doctor communication, hospital rating, and hospital recommendation. Furthermore, HCAHPS scores for minorities were higher at hospitals with greater cultural competency on four other dimensions: nurse communication, staff responsiveness, quiet room, and pain control.”

NCBI also found that “quality of interpretation correlates with patient understanding and satisfaction with the encounter.”

Need more information about how CMS Star Ratings are calculated and how LEP patients may impact them? Download our whitepaper to learn more:

Guide CMS Hospital Star Ratings