CMS will not release updated hospital star ratings in August as expected and is delaying their release until further notice while a panel of experts reviews the methodology and proposes changes, according to an agency spokesperson, Maria Castellucci reports for Modern Healthcare.

Get the cheat sheet on how CMS calculates their star ratings

The star ratings were last updated in late February, after a 14-month hiatus. Before that, Castellucci reports CMS had released star ratings about every six months. Based on that schedule, new ratings were expected next month.

How CMS hospital star ratings work

CMS' Hospital Compare website's Overall Hospital Quality Star Ratings rate more than 4,000 U.S. hospitals on scale of one to five, with five stars being the highest. The overall hospital star ratings are based on 57 quality measures across seven categories:

• Effectiveness of care;
• Efficient use of medical imaging;
• Mortality;
• Patient experience;
• Readmissions;
• Safety of care; and
• Timeliness of care.

However, several studies have questioned the agency's methodology and hospital groups have raised concerns about the stars' accuracy.

In response, CMS in the February ratings, relied less on patient experience and put more weight on prompt care and readmissions rates. CMS in the February update also used k-means clustering under which the agency repeatedly categorized hospitals into the five star-rating groups until the hospitals in each group were sufficiently similar to each other and distinct from hospitals categorized in other groups. Previously, CMS had relied on the winsorization method to limit "extreme hospital outliers" in the data and "minimize their effect on the overall ratings."

CMS said it continued to weigh each hospital's average score for each of the seven quality categories in the same way as in previous methodologies.

The agency also suggested it was considering additional changes to the hospital star ratings methodology, though it said those were "long-term" considerations that would not take effect until the 2020 quality reporting year or later. For example, in a 48-page request for feedback, the agency wrote that it is considering replacing its current model with a more explicit approach, such as using an average of the quality measurements on which the ratings are based. 

CMS accepted public comments on the proposal through March 29.

CMS delays changes to hospital star ratings

An agency spokesperson told Modern Healthcare that CMS received more than 800 comments on the proposal and that it does not plan to update the hospital star ratings until a panel of technical experts can review the feedback.

The agency has not yet set a time for the technical expert panel to meet to review the comments, Castellucci reports. CMS will accept nominations for members of the technical expert panel but has yet to do so, Castellucci reports.

The CMS spokesperson said hospitals should already be aware that their new star ratings will not be released as scheduled since the ratings were absent from the agency's recent Hospital Compare data preview reports. The spokesperson estimated the comments the agency received on the proposal will be ready for public release later this summer after the technical expert panel reviews them and recommends next steps.

The CMS spokesperson said the move ensures that the agency's "priority remains ensuring Hospital Compare provides consumers meaningful, easy-to-use information on hospital safety and quality that empowers them to make informed decisions about their care."

AHA supports the move

The American Hospital Association (AHA) said it backs CMS' decision to delay releasing the ratings. "The AHA appreciates that CMS, as we have urged, is seeking further expert input on its star ratings methodology," Ashley Thompson, AHA SVP of policy, said in a statement. "We continue to believe that the agency must improve the accuracy and meaningfulness of star ratings before they are republished" (Castellucci, Modern Healthcare, 7/12).