Last week the Centers for Medicare and Medicaid Services (CMS) released its first 5-star rating system of hospitals in the United States. According to this system a hospital can earn a rating of anywhere from one to five stars with a score of 5-stars given to the best performing hospitals on a set of measures. As an organization our system had three hospitals with 3-stars and one with 1-star. The scores across our health care system are a microcosm for what many believe is a fundamental flaw within the scoring system. The ratings disadvantage hospitals that care for the sickest patients, especially those that take patients as emergent transfers, and favor small niche hospitals that take care of a narrow population of patients primarily through planned admissions.
The star ratings don’t take into account important differences in patient populations and the complexity of conditions hospitals treat. It is especially unfair to teaching hospitals like our academic medical center, and particularly those that alone serve the acute health care needs of a large region like our medical center. According to the Association of American Medical Colleges (AAMC):
“CMS was able to use more than 60 measures to calculate ratings for teaching hospitals and as few as nine measures on some hospitals that treat patients with less complex conditions or that specialize in a limited number of conditions. Analysis of the ratings has confirmed that the lower the number of measures a hospital reported, the more likely a hospital was to receive a higher star rating. In fact, hospitals that reported on 60 percent of the metrics or less received almost half of the five-star ratings.”
I believe transparency of data is a good thing; for example, it is fair to compare our severity-adjusted myocardial infarction mortality rate to other hospitals that take care of patients with an acute myocardial infarction (AMI), but it is unfair to compare the medical center, through a star ranking system, to hospitals that don’t take care of AMI patients or transplant patients or traumas.
As I said to the Boston Globe, “the star ratings are an irresponsible slap in the face to hospitals that take care of the sickest patients under the most challenging situations.”
As an organization, we all have areas we need to work on to reach our True North goal of becoming the best place to give care and the best place to get care. Quality is our number one priority and significant work is being done across our health care system to assure continuous improvement of the care we deliver to each and every patient we care for.
We are committed to the cause of patient-centered care and that is what we should spend our time, energy and resources on —not chasing ratings or rankings.
Whether you work at one of our 3-star or 1-star rated hospitals, I am incredibly proud of the great work you do here every day and ask that we continue to collectively focus on continuous improvement in all that we do..
Thanks for taking great care of our patients and one another,