Dr Ashish K. Jha Discusses the Controversial Medicare Hospital Star Ratings

CMS' star ratings for hospitals have been controversial because they penalize hospitals that disproportionately care for the poor and the sick, and efforts by CMS to adjust the methodology haven't really addressed the concerns, explained Ashish K. Jha, MD, MPH, the K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute.

Transcript (slightly modified)

There have been concerns over the Medicare stars program for hospitals. What are the issues people have regarding the penalties safety net and teaching hospitals are facing?

The hospital star ratings are relatively new and the concerns that people have outlined behind them are sort of several. One, there's a big picture question of, can you even take a hospital, which is a big complicated place, and give a single star rating that really captures the quality of care in that place? There's sort of a philosophical question of "is it even doable to give a single rating that really captures how good an institution is?"

The second, which is a more specific set of concerns, is when you look at the star ratings, when you look at the underlying methodology, what becomes really clear is that hospitals that disproportionately care for sick patients, hospitals that disproportionately care for poor patients are going to be far more likely to be penalized. And actually there are some reasons to believe that hospitals that are good, that are vigilant, that look for errors, that look for adverse events that might happen, are also much more likely to end up getting a bad rating.

And so the concerns are methodologic, really saying, "Look, we don't want to be calling the best hospitals—the ones that take care of the hardest patients, the sickest patients, the poorest patients—we don't want to be calling them 1, 2, or 3 stars when they're really some of the best hospitals in America."

CMS did make some changes to the methodology of the Medicare stars program for hospitals before releasing the ratings. What was the purpose of those changes and do you think they were enough to make a real impact on the final rating of a hospital?

So when CMS initially put out that it was going to have these star ratings, there was a lot of pushback. Individual hospitals got to look at their own star ratings and it appeared that some of the best hospitals in America were going to be rated poorly. So I think there was pushback on that. So CMS went back—the Yale Group that developed this measure went back and re-ran some analyses.

Does it fundamentally address the concerns that hospitals and others have raised? No, it doesn't. There were issues around giving poor scores to organizations that disproportionately care for the poor, disproportionately care for sick patients. Those issues are still in play. The effort was just trying to make it a little bit better, so that the program has a little more validity.