Logan Reid
The hospital star rating system is a ranking system that conveys hospital quality in an easy-to-interpret way for patients. The system was launched in 2016 and is updated at least once a year. The star ratings are based on various quality measures, including mortality, safety of care, readmission rates, patient experience, and timely and effective care. Hospitals submit measures through regulatory programs, and these measures are used to assess performance on value programs. The calculation methods for star ratings are complex and can be sensitive to changes, affecting a hospital's rating. The ratings are designed to provide patients with an accessible way to compare hospitals and make informed choices about their care.
| Characteristics | Values |
|---|---|
| Who assigns the ratings | CMS (Centers for Medicare & Medicaid Services) |
| What are the ratings based on | 46 quality measures in five groups: mortality, safety of care, readmission rates, patient experience, and timely and effective care |
| How often are the ratings updated | At least once a year |
| How are the ratings calculated | CMS selects the measures, takes the hospital's performance on those measures, and standardizes the measure score using Z-scoring |
| How many hospitals received ratings in 2024 | 2,846 |
| How have the ratings changed over time | In 2024, 22% of hospitals gained a star and 27% lost a star |
| How does peer grouping affect the ratings | Hospitals in peer groups may have their ratings affected by the performance of other hospitals in their group |
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What You'll Learn
Star rating categories
Star ratings for hospitals were launched in 2016 by CMS with the aim of conveying hospital quality in a simple way for patients to interpret. The ratings are based on 46 quality measures in five groups, and hospitals must report at least three measures in at least three groups, including either mortality or safety, to receive a rating.
The five groups that the measures fall into are:
- Mortality
- Safety of care
- Readmission rates
- Patient experience
- Timely and effective care
The ratings are distributed on a bell curve, with most hospitals falling in the middle range of three stars. A small number of hospitals receive one or five stars, indicating the worst and best performers, respectively.
It's important to note that hospital star ratings have some limitations. Firstly, the ratings are based on data that may be months or even years old, which can diminish their relevance for patients seeking current care options. Additionally, the ratings do not always correlate closely with performance on specific condition-related measures, such as cancer or stroke care. Experts advise patients to consider multiple sources of information, including specific measures relevant to their care and a hospital's specialty certifications.
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How hospitals are scored
Hospital ratings are based on a multitude of factors, including patient satisfaction, safety, and clinical performance. U.S. News, for example, ranks the best hospitals by state, specialty, and other factors. They use mixed-effects models to analyze claims-based outcomes when evaluating hospital performance. This includes data on 30-day mortality rates following admission and claims data obtained from the Centers for Medicare & Medicaid Services' (CMS) Standard Analytic File and the Medicare Provider Analysis and Review (MedPAR) file. U.S. News also considers outpatient complication rates for certain specialties, such as Ear, Nose & Throat, Orthopedics, and Urology.
The Hospital Safety Grade, on the other hand, focuses specifically on patient safety and scores hospitals on their ability to protect patients from errors, injuries, accidents, and infections.
Patient satisfaction is another important aspect of hospital ratings. Most hospitals are required to assess patients' satisfaction using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a government-administered survey. The HCAHPS survey covers areas such as nurse staffing, patient volume, and the use of clinically proven technologies.
Expert opinion is also sometimes considered in hospital ratings. Board-certified physicians in each specialty are invited to list the hospitals they consider the best in their area of expertise, and these opinions are factored into the overall rankings. However, it's important to note that many highly-ranked hospitals have low or even zero expert opinion scores, demonstrating that clinical performance is a more significant factor.
Additionally, U.S. News evaluates hospitals across a wide range of conditions and procedures, with specific ratings for areas such as cardiology and thoracic surgery. Hospitals are given an overall rating of "High Performing," "As Expected," or "Evaluated," indicating how they compare to the national average in a given procedure or condition.
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How hospitals perform
The hospital star rating system was launched in 2016 to convey hospital quality in a way that is easy for patients to interpret. The CMS releases star ratings for nearly all U.S. hospitals at least once a year. The star rating is made up of five categories: mortality rates, patient readmissions to the hospital, safety of care, timely and effective care, and the patient experience. Within each category are a set of measures that hospitals have submitted through their various regulatory programs or that CMS has gathered through claim submissions. Hospitals must report at least three measures in at least three groups, including either mortality or safety, to get a star rating.
The star rating is calculated using a statistical technique called Z-scoring, which standardizes all measure scores so they make sense in the overall equation. A Z-score is a standard deviation score that shows the amount of variation in a dataset. For the star rating, Z-scores are produced by subtracting the national mean score from each hospital's measure score and dividing that by the standard deviation across hospitals.
In addition to the star rating system, there are also private rating systems that focus on different aspects of quality and use different scoring methods. A 2015 study found limited agreement between the star ratings and three other systems. A hospital's rating can change if other hospitals in its peer group perform better or worse, or if its peer group assignment changes.
It's important to understand the limitations of star ratings. They don't always correlate closely with performance on condition-related quality measures such as cancer or stroke care. Star ratings are just one source of information for patients to consider when choosing a hospital. Experts advise patients to examine measures specific to their care, seek advice from a physician, and consider a hospital's specialty certifications.
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Limitations of star ratings
Star ratings for hospitals are designed to convey hospital quality in a simple, easy-to-interpret way for patients. However, they have several limitations that users should be aware of.
Firstly, star ratings are based on a limited number of measures, which may not fully capture the complexity of hospital performance. For example, they may not correlate closely with performance on specific condition-related quality measures, such as cancer or stroke care. As such, patients should consider a range of factors when choosing a hospital, including measures specific to their care needs and the hospital's specialty certifications.
Secondly, the methodology used to calculate star ratings can significantly impact the final rating. A 2022 study found that star ratings were highly sensitive to changes in the underlying methodology, including how measures are assessed or weighted. This means that small changes in the methodology could potentially lead to significant changes in a hospital's rating.
Thirdly, star ratings may not always account for the unique characteristics of different hospitals, such as bed size, geography, and critical access status. Critical access hospitals, for example, are often located in rural areas and may not treat enough patients to meet the reporting thresholds for star ratings.
Additionally, star ratings may not reflect the most up-to-date information about a hospital's performance. The data used to calculate star ratings can be months or even years old, and may not capture recent improvements or declines in quality.
Furthermore, star ratings do not consider social risk factors or community factors that can impact patient outcomes. Hospitals in marginalized communities may face challenges such as homelessness, disability, and lack of access to follow-up care, which can affect measures such as mortality and readmission rates, but these factors are not currently included in star rating calculations.
Lastly, star ratings are subject to the limitations of the rating system itself. For example, crowdsourced star ratings, such as those on web-based portals, may not accurately reflect the true quality of care due to the non-representative nature of the sampling process, the lack of expertise of raters, and the potential for manipulation. Expert rating systems, such as those published by the Centers for Medicare & Medicaid Services (CMS), are more comprehensive and based on multiple measures of quality, but even these systems have been revised to address inconsistencies and limitations.
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How hospitals can improve their rating
Hospitals can employ several strategies to enhance their star ratings, which are determined by Medicare's Hospital Star Ratings system, ranking over 4000 hospitals on a scale of one to five, with five being the best score. Here are some ways hospitals can improve their ratings:
Firstly, hospitals should focus on specific measures that carry more weight in the rating system. By targeting these measures, hospitals have a greater chance of boosting their overall rating. However, it's important to understand that the rating system uses a comparative methodology, so hospitals must also be aware of their performance relative to their peers. This means that underperforming hospitals may need to make significant improvements to see a noticeable change in their rating.
Communication is another critical aspect of enhancing hospital ratings. Improving patient experience and engagement starts with effective communication. This includes ensuring that patient-facing staff introduces themselves, explains procedures, sets clear expectations, and treats patients and their families with dignity and respect. Providing patients with access to healthcare information, patient portals, and engagement platforms is important, but it's equally crucial to focus on the basics of patient interaction.
Leadership engagement is also key to quality improvement. Hospital leadership should be actively involved in direct care environments, and their engagement level should be monitored. Leaders must also be kept informed about changes in performance, the financial implications of poor performance, and how the hospital compares in rating programs. Disseminating information, providing ongoing education, and training for front-line staff are essential components of leadership responsibility.
Additionally, hospitals can benefit from utilizing simulation tools that offer insights into the most statistically efficient measures to target. These tools can also help hospitals stay on track by indicating the time frame for impacting performance. By leveraging these tools, hospitals can make data-driven decisions to optimize their performance and, consequently, their star ratings.
Furthermore, hospitals should pay attention to the socioeconomic status of their patients. Lower-income patients with less education tend to be in worse health upon admission and may face challenges in obtaining or managing care after discharge. By addressing these disparities and improving care equality, hospitals can positively impact their ratings.
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Frequently asked questions
The hospital star rating system was launched in 2016 to convey hospital quality in an easy-to-interpret way for patients. It uses a one-to-five-star ranking system, with one star indicating poor performance and five stars indicating excellent performance.
Star ratings are based on quality measures in five groups: mortality, safety of care, readmission rates, patient experience, and timely and effective care. Hospitals must report at least three measures in at least three groups, including either mortality or safety, for a star rating. CMS selects the measures used for the rating, taking into account the hospital's performance and standardizing the measure score.
The hospital star rating system is updated at least once a year.
Star ratings are based on data that may be months or years old. They also do not correlate closely with performance on condition-related quality measures such as cancer or stroke care. Experts advise patients to consider multiple sources of information, including specific measures related to their care, when choosing a hospital.
