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The star rating system for hospitals of the Centers for Medicare and Medicaid Services (CMS) pools all hospitals together and awards each institution one to five stars for quality, despite variation across hospitals in the numbers and types of measures they report. Thus, hospitals essentially are being evaluated differently, which affects the validity of quality comparisons. We considered the number and types of measures reported and the size of measure denominators to represent different forms of a "test," and we used data from the December 2017 star ratings to show that hospitals took one of three general "test forms." Hospitals taking the most extensive test form reported an average of forty-three measures, while those taking the least extensive test reported an average of twenty-two measures. These test forms were differentially associated with star ratings and hospital characteristics. Our results caution against pooling all hospitals together when assigning star ratings, and they demonstrate a feasible approach to segmenting hospitals into peer groups for evaluation by stakeholders such as CMS.
This article was published in the following journal.
Name: Health affairs (Project Hope)
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A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.
The voluntary portion of Medicare, known as the Supplementary Medical Insurance (SMI) Program, that includes physician's services, home health care, medical services, outpatient hospital services, and laboratory, pathology, and radiology services. All persons entitled to Medicare Part A may enroll in Medicare Part B on a monthly premium basis.
Uniform method for health care providers and medical suppliers to report professional services, procedures, and supplies. It consists of alphanumeric codes and modifiers for the use of all public and private health insurers. It is developed by the Centers for Medicare and Medicaid Services.
Coordination of coverage eligibility of those individuals who are entitled to MEDICAID and MEDICARE.
Information centers primarily serving the needs of hospital medical staff and sometimes also providing patient education and other services.