MedPAC and the 5-star rating systems

MedPAC, an independent congressional agency that advises Congress on Medicare issues, is telling the Centers for Medicare & Medicaid Services (CMS) to reconsider the recently introduced five-star rating system created to rate the nation’s hospitals. It’s the latest in a long era of disgruntlement with the CMS rating systems, including those that rate nursing homes.

In a letter to CMS Acting Administrator Andy Slavitt, MedPAC Chair Francis Crosson, MD, called out several aspects of the new hospital star rating program, saying it doesn’t account for nuances in how and why patients are admitted to hospitals and “may not produce a true ‘apples-to-apples’ comparison.” For example, Crosson noted, the more patients who are admitted through the emergency department, the lower the star rating tends to be.

But, MedPAC’s biggest complaint is that the new program is yet another thing providers must report, often using data they’ve already submitted to CMS. “[T]here are currently too many, overlapping hospital quality payment and reporting programs, which creates unneeded complexity in the Medicare program,” the MedPAC letter continued. “The Commission encourages CMS to align the star rating methodology as much as possible with existing CMS programs, for example the Hospital Value-based Purchasing (VBP) program, which scores hospitals on a comprehensive set of quality and cost measures, and redistributes payments from lower-to higher-performing hospitals.”

Another of CMS’ rating systems, the Nursing Home Compare, has been under fire for years for the way its scores are derived. In early 2015, a change in the algorithm caused many nursing homes to drop a star in their ratings practically overnight. Since then, several new quality measures have been added to the calculations. The latest statements from MedPAC seem to show shrinking support for having multiple quality measurement programs, but time will tell if the Nursing Home Compare rating system will see further changes.

Topics: Medicare/Medicaid , Regulatory Compliance