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Up for debate: CMS Star Ratings released

tracey walker | managed healthcare executive | 3 august 2016 

PA healthcare experts, Nilesh Chandra and Jeff Cameron, are quoted in an article in Managed Healthcare Executive. The article discusses the debate around CMS moving forward with releasing the Overall Hospital Quality Star Ratings, despite some pressure from hospital groups and other stakeholders to delay it.

Commenting on this topic, Nilesh states: “This is a first attempt and more an indication of the shape of things to come, rather than the definitive stars rating program.  CMS might have wanted to get the ball rolling on this before the election.”

Nilesh continues: “Over the last few years, CMS has collected a lot of quality and outcomes data through its various quality reporting programs—the physician quality reporting system (PQRS), the qualified clinical data registry (QCDR), etc.—and this shows that CMS is finally putting all that data to use.  These ratings do not enable an apples-to-apples comparison, because the amount of data captured—only Medicare-eligible, all patients—and the quality measures vary widely both across specialties and based on the QCDR provider.”

Nilesh expounds further, stating: “However, over time, we will see a narrowing of criteria and using these quality measures will drive changes to clinician behavior that result in improved clinical outcomes at lower cost for all. If we consider the hospital stars ratings as a first step, rather than the final set of ratings; this program seems to be the right first step in the right direction.”

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Jeff adds: “There is some concern over the star rating being too directly tied to the community.”

Jeff concludes by detailing how the CMS Star Ratings would benefit certain communities over others, commenting: “For instance, services available in each community will result in higher ratings, and basically provide the affluent with the majority of the financial rewards. In essence the star rating is a system that promotes the rich getting richer and the poor staying poor. Therefore it stands to reason that a more affluent location has a much higher likelihood to have a CMS star rating above 4.0. If CMS put a community adjustment into the overall score, there would be a more accurate measurement that can be used for comparison.”

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