In an effort to make comparing hospitals more like shopping for refrigerators and restaurants, the federal government has awarded its first star ratings to hospitals based on patients’ appraisals.
Many of the nation’s leading hospitals received middling ratings, while comparatively obscure local hospitals and others that specialized in lucrative surgeries frequently received the most stars.
Evaluating hospitals is becoming increasingly important as more insurance plans offer patients limited choices. Medicare already uses stars to rate nursing homes, dialysis centers and private Medicare Advantage insurance plans. While Medicare publishes more than 100 quality measures about hospitals on its Hospital Compare website, many are hard to decipher, and there is little evidence consumers use the site very much.
Many in the hospital industry fear Medicare’s five-star scale won’t accurately reflect quality and may place too much weight on patient reviews, which are just one measurement of hospital quality. Medicare also reports the results of hospital care, such as how many died or got infections during their stay, but those are not yet assigned stars.
“We want to expand this to other areas like clinical outcomes and safety over time, but we thought patient experience would be very understandable to consumers so we started there,” Dr. Patrick Conway, chief medical officer for the Centers for Medicare & Medicaid Services, or CMS, said in an interview.
Medicare’s new summary star rating, posted Thursday on Hospital Compare, is based on 11 facets of patient experience, including how well doctors and nurses communicated, how well patients believed their pain was addressed, and whether they would recommend the hospital to others. Hospitals collect the reviews by randomly surveying adult patients – not just those on Medicare — after they leave the facility.
In assigning stars, Medicare compared hospitals against each other, essentially grading on a curve. It noted that “a 1-star rating does not mean that you will receive poor care from a hospital” and that “we suggest that you use the star rating along with other quality information when making decisions about choosing a hospital.”
Some hospital officials doubt that the differences are that significant. “A one point difference can change you from a two-star to a three-star hospital,” said Lisa Allen, chief patient experience officer for Johns Hopkins Medicine in Baltimore. “I’m not sure they’ve designed it to truly differentiate a hospital that provides a great experience from one that doesn’t.”
Deneen Richmond, an executive at the Inova hospital system in Northern Virginia, said the star ratings should encompass more than one aspect of a hospital. “I’m a Consumer Reports junkie, and I look at Trip Advisor whenever I’m out of town, but the difference is those ratings are comprehensive and take in multiple dimensions, whether it’s for a restaurant or a hotel,” she said.
The American Hospital Association also issued a caution to patients, saying: “There’s a risk of oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons.”
Nationally, Medicare awarded the top rating of five stars to 251 hospitals, about 7 percent of all the hospitals Medicare judged, a Kaiser Health News analysis found. Many are small specialty hospitals that focus on lucrative elective operations such as spine, heart or knee surgeries. They have traditionally received more positive patient reviews than have general hospitals, where a diversity of sicknesses and chaotic emergency rooms make it more likely patients will have a bad experience.
A few five-star hospitals are part of well-respected systems, such as the Mayo Clinic’s hospitals in Phoenix, Jacksonville, Fla., and New Prague, Minn. Mayo’s flagship hospital in Rochester, Minn., received four stars.
Medicare awarded three stars to some of the nation’s most esteemed hospitals, including Cedars-Sinai Medical Center in Los Angeles, NewYork-Presbyterian Hospital in Manhattan, and Northwestern Memorial Hospital in Chicago. The government gave its lowest rating of one star to 101 hospitals, or 3 percent.
On average, hospitals scored highest in Maine, Nebraska, South Dakota, Wisconsin and Minnesota, KHN found. Thirty-four states had zero one-star hospitals.
Hospitals in Maryland, Nevada, New York, New Jersey, Florida, California and the District of Columbia scored lowest on average. Thirteen states and the District of Columbia did not have a single five-star hospital.
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In total, Medicare assigned star ratings to 3,553 hospitals based on the experiences of patients who were admitted between July 2013 and June 2014. Medicare gave out four stars to 1,205 hospitals, or 34 percent of those it evaluated. Another 1,414 hospitals—40 percent— received three stars, and 582 hospitals, or 16 percent, received two stars. Medicare did not assign stars to 1,102 hospitals, primarily because not enough patients completed surveys during that period.
While the stars are new, the results of the patient satisfaction surveys are not. They are presented on Hospital Compare as percentages, such as the percentage of patients who said their room was always quiet at night. Until now Medicare did not indicate what differences it considered significant. In addition to the summary star rating, Medicare assigned stars to each of the patient satisfaction areas, but those stars are not as prominently displayed on its website. Medicare also uses patient reviews in doling out bonuses or penalties to hospitals based on their quality each year.
Some groups that do their own efforts to evaluate hospital quality questioned whether the new star ratings would help consumers. Evan Marks, an executive at Healthgrades, which publishes lists of top hospitals, said it was unlikely consumers would flock to the government’s rating without an aggressive effort to make them aware of it.
“It’s nice they’re going to try to be more consumer friendly,” he said. “I don’t see that the new star rating itself is going to drive consumer adoption. Ultimately, you can put the best content up on the Web, but consumers aren’t going to just wake up one day and go to it.”
Jean Chenoweth, an executive at Truven Health Analytics, which also publishes its own list of top hospitals, said she feared hospital marketing departments would oversell the meaning of the stars. “It would be very unfortunate and misleading if a hospital marketing department could claim to be a CMS five-star hospital and fail to mention it only reflected a patient’s perception of care,” she said.