The Affordable Care Act includes many provisions aimed at improving the quality of care provided by different types of health care professionals and providers. Along these lines, the ACA expands the types of facilities and providers for which quality data will be publically available. The Secretary of the United States Department of Health and Human Services was therefore directed to develop a Hospital Compare website (amongst other similar sites such as Physician Compare and Nursing Home Compare) that would allow Medicare enrollees to compare scientifically sound measures of physician quality and patient experience.
In accordance with these directives, on April 16, 2015 the Centers for Medicare and Medicaid Services (“CMS”) released the first ever Hospital Compare Star Ratings on its public information website. The site is intended to make it easier for consumers to choose a hospital and understand the quality of care they deliver. The data set from the website contains hospital-specific quality data for over 4,500 hospitals nationwide. The ratings are based on the 11 publicly reported measures in the Hospital Consumer Assessment of Healthcare Providers and Systems (“HCAHPS”) survey, which assesses patient experiences.
The star ratings allow for an easy comparison using a five-star scale, with more stars indicating better quality care. The quality data on Hospital Compare includes clinical process of care, patient outcomes and patient experience of care measures. The national rankings are based on hospitals’ performance on the clinical process of care measures and a national survey of patients’ experience of care. The hospitals’ ranks are combined into an overall, composite performance ranking, with process of care measures contributing 70% and patient experience of care measuring 30%.
However, just 251 out of 3,553 hospitals received the highest score in the rating system based on the experiences of patients who were admitted between July 2013 and June 2014. Hospitals had an opportunity to preview the ratings in the fall and many have already expressed concern. Hospitals question the methodology and whether the ratings reflect meaningful reflections of performance. They also assert that the ratings are oversimplifying the hospital’s performance to a single score.
Notably, the patient experience star ratings are only based on the information on quality of care that is reported by patients. The surveys are provided to a random sampling of patients within two days after discharge from a hospital and must be completed within 42 days. Further, positive results may mean that the hospital is delivering good care. However, these results are not taking into account other factors such as timely and efficient care and results or outcomes of care measures. Moreover, the results places substantial reliance on patient review, which is just one measurement of hospital quality. Lastly, if one does not review Hospital Compare extensively, information aside from the star ratings may easily be overlooked. For example, the complete results for each HCAHPS measure can be found in the “Survey of Patients’ experiences” section.
On the other hand, supporters of Hospital Compare argue that while it’s not a perfect measurement system, it creates a healthy competition among hospitals.