How CMS calculates hospital star ratings

In 2021, CMS finalized updates to the methodology of its hospital star ratings, changing the number of measures considered and the reporting thresholds to receive a star rating, and placing hospitals into peer groups based on the number of measures they report.

This year, the hospital star ratings were based on 46 quality measures in five different categories:

1.       Mortality (22%)

2.       Safety (22%)

3.       Readmission (22%)

4.       Patient experience (22%)

5.       Timely and effective care (12%)

If a hospital reported no data for measures in a certain group, the weighted percentage was redistributed proportionally to other groups.

Depending on the measure, CMS used hospital data collected from July 2018 to March 2022 for its latest rankings.  

How hospitals performed

Of the 3,076 hospitals that received a star rating:

• 483 received a five-star rating, compared to 429 last year
• 803 received a four-star rating, compared to 890 last year
• 872 received a three-star rating, compared to 890 last year
• 668 received a two-star rating, compared to 693 last year
• 250 received a one-star rating, compared to 192 last year

An additional 1,578 hospitals did not receive a star rating due to a lack of sufficient data.

Commentary

Among the different hospitals, Veterans Health Administration (VHA) hospitals had the most five-star ratings. Roughly 32% of VHA hospitals received five-star ratings, compared to 21% of critical access hospitals and 15% of acute care hospitals.

According to Modern Healthcare, most hospitals did not see much change in their star rating from 2022 to 2023. Almost half of hospitals kept the same rating they had in 2022 while 28% saw a decrease, and 24% saw an increase.

Rick Kes, a healthcare senior analyst at RSM, said many hospitals have been prioritizing safety and quality efforts over the last few years since certain measures, such as readmissions and hospital-acquired infections, are tied to reimbursement.

"Despite all the headwinds and the staffing challenges, the COVID-19 emergency and massive increases in expenses, you're not seeing a ton of hospitals fall off the radar when it comes to star ratings," Kes said. He also noted that higher star ratings can help hospitals market themselves and stand out in their communities.

Regarding the updated methodology to the star ratings, some hospital leaders say there are still areas that can be improved, and that CMS should continue listening to public feedback.

"A next step may be to look at, 'Are there more inpatient measures related to timely and effective care that might be appropriate for the star rating?'" said April Taylor, COO of Johns Hopkins Hospital. (Devereaux, Modern Healthcare, 8/4; Heath, PatientEngagementHIT, 7/28; CMS Overall Hospital Quality Star Ratings, accessed 8/4)

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