What is a “Star Rating” and why Should You Care?

If you have read some of my previous posts, you know I have pointed out that judging healthcare quality is a muddled proposition at best.  Even for those of us that work in healthcare, it is very hard to make a clear recommendation about what hospital or doctor is “best”.  A big part of the problem is a nearly universal lack of precise information: what surgeon has the best outcomes, for example—how do you define what is best?  Some things are tracked, such as how likely a patient is to get a serious infection, need a blood transfusion, or be readmitted to the hospital due to a complication.  Other things we have not really begin to measure, such as how effectively surgery may relieve (or cause) pain, how quickly a patient recovers, and how soon they get back to work.  While patient satisfaction surveys are common, they don’t ask specific questions like this, and are usually filled out within 30 days of the encounter. Nobody really asks someone who had a knee replacement if they have gotten back to golf, jogging, or other things they enjoy six months or a year later—the data doesn’t exist.

Choosing a “best hospital” is bit like choosing a spouse—you may look at some objective criteria, but ultimately it comes down to the best fit for both of you.  Think about choosing a hospital in the same way—what is the best fit?

 

To make things a little easier on the average healthcare consumer (formerly known as a patient ☺) the Centers for Medicare & Medicaid Services publishes Star Ratings each year to measure quality in Medicare Advantage and Prescription Drug Plans, assist beneficiaries in finding the best plan for them, and determine MA Quality Bonus Payments. Moreover, the ratings support the efforts of CMS to improve accountability for the care provided by physicians, hospitals, and other providers.

 

How the Star Ratings are calculated varies depending on whether it is an insurance plan, hospital, nursing home, or other facility.  For hospitals, overall ratings summarize up to 57 quality measurements across seven areas of quality into a single star rating for each hospital. The major domains measured are:

 

  1. Mortality
  2. Safety of Care
  3. Readmission
  4. Patient Experience
  5. Effectiveness of Care
  6. Timeliness of Care
  7. Efficient Use of Medical Imaging

 

Not every hospital or plan is high-performing (5 stars).  The distribution of Star Ratings for hospitals in 2017 was as follows:

 

Overall Rating Number of Hospitals (N=4,579, %)
5 stars 337 (7.36%)
4 stars 1155 (25.22%)
3 stars 1187 (25.92%)
2 stars 753 (16.44%)
1 star 260 (5.68%)
N/A 887 (19.37%)

 

For Medicare plans, rather than hospitals, most are clustered in the range of 3.5-4.5 stars, but it is harder to reach the maximum of 5 stars in health plans than in hospital ratings.  The measurement domains are a little different too, but there is overlap. The domains include:

  • Outcomes
  • Intermediate Outcomes
  • Patient Experience
  • Access
  • Process

 

Another way of looking at this is the following:  If your hospital is 2 Stars or less, it is in the bottom third.  If your Medicare Advantage plan is 3.5 Stars or less, it too is in the bottom third,  

 

If you have other options in your area you should probably consider them.

Further reading:

 

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-10-12.html

 

https://www.medicare.gov/hospitalcompare/Data/Hospital-overall-ratings-calculation.html