The Center for Medicare and Medicaid Services (CMS) recently previewed their February 2019 updates to the Hospital Compare system, which provides hospitals their Overall Quality Star Ratings. The expected changes were available for hospital review during December 2018 and have raised concerns that Hospital Compare may adversely impact organizations treating disadvantaged patients.
The new controversy hinges on the issue of readmission rates among dual-eligible patients – those eligible for both Medicare and Medicaid. The healthcare community has long understood that dual-eligible patients are more likely to readmit, since they are older and less financially secure. Age and poverty are both risk factors for poor outcomes and readmission, so a hospital treating a larger share of dual-eligible patients should expect more readmissions.
CMS itself recognized this reality in the past, adapting their Hospital Readmissions Reduction Program to consider a hospital’s proportion of dual-eligible patients before penalizing them for high readmission rates. The logic here seems clear: penalizing hospitals for readmissions they can control may make sense; penalizing them for the age and socioeconomic makeup of their patient population does not.
Yet in the 2019 Hospital Compare preview, CMS does not consider a hospital’s proportion of dual-eligible patients when assessing their readmission rates. And since readmission rates account for 22% of a hospital’s overall Star Rating, hospitals treating dual-eligible patients saw their scores dip significantly.
CMS has responded to hospital concerns by saying that their decision to consider readmission rates in the Hospital Readmissions Reduction Program was required by the 21st Century Cures Act of 2016, and that "only applies to payment adjustment. This methodology is not a measure-level risk adjustment and is therefore not part of the overall hospital quality star ratings."
In other words, since the Hospital Compare Star Rating system does not impose direct financial penalties on hospitals, CMS is not legally required to consider dual-eligible patients when assessing readmission rates for Hospital Compare.
The updated rating system is set to go into effect in February of 2019. Hospitals with concerns can contact the CMS Hospital Compare Overall Ratings Team at firstname.lastname@example.org
Ready for a refresher on how CMS Hospital Compare calculates a hospital’s Overall Star Rating? Download our whitepaper on the topic to see the formula – and how improving care for limited-English proficient patients can improve a hospital’s rating: