The Definitive Blog

New Data Highlight: Updated Hospital Quality Metrics

CMS releases updated quality data on a quarterly basis.  The latest update was released in October, and included updates to:

  • Hospital overall star ratings
  • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings
  • Timely and Effective Care
  • Healthcare-Associated Infections

Definitive Healthcare has incorporated these updates into its databases and reviewed them to see what they say about hospital quality.

The update contains CMS’ second review of overall hospital quality star ratings. CMS issued scores for roughly 3,600 hospitals, about the same number as in July 2016 when the scores were introduced. About 900 hospitals eligible for ratings were excluded due to a lack of reported data, a figure similar to the previous rating period. The following chart shows the current breakdown of hospitals by this star rating:

Hospitals by Overall Quality Start Rating

hospitals-by-overall-quality-star-ratingCompared to July, hospital scores improved slightly. Nine more hospitals received 5-star ratings, and 30 more received 4 stars. Overall, though, the general distribution has not changed significantly, which is not surprising given the short time interval. It’s important to note that while the ratings are derived from several quality and clinical measures, only those indicated above have been updated since July and so form the basis of any changes.

The latest update also includes new data on healthcare-associated infections (HAIs), a significant problem in the healthcare industry that leads to thousands of deaths and billions in additional spending annually. CMS requires hospitals to report all HAIs in order to track infection rates as well as establish reimbursement penalties for facilities with excessive numbers of infections. Rather than provide a simple number for HAIs, which could give a misleading impression of hospitals that treat more complex and vulnerable patients, CMS calculates a ratio called the standardized infection ratio (SIR), which compares the actual number of HAIs for a hospital to the predicted number, which is adjusted to account for the patient population treated at the hospital. While CMS does not report HAI scores at hospitals with SIRs less than 1, excluding data on more than half of all hospitals for most measures, the available information is nonetheless useful and illustrates the difference in quality among hospitals by star rating, as shown below.

Average SIR by HAI and Star Rating

HAI Total 5 Star 4 Star 3 Star 2 Star 1 Star
 SSI Colon 0.95 0.96 0.88 0.93 1.00 1.17
 CAUTI 0.57 0.58 0.55 0.53 0.62 0.69
 SSI Hysterectomy 0.75 0.71 0.92 0.81 0.79 1.18
 MRSA  0.74 0.74 0.86 0.81 0.87 0.83
 C Diff  0.81 0.54 0.80 0.81 0.87 0.83
 CLABSI  0.53 0.40 0.45 0.54 0.57 0.67

Key: SSI (Surgical Site Infection), CAUTI (Catheter-Associated Urinary Tract Infection), MRSA (Methicillin-Resistant Staphylococcus Aureus), C Diff (Clostridium Difficile), CLABSI (Central Line-Associated Bloodstream Infection)
Source: Definitive Healthcare

The data indicates that for all measures, 5- and 4-star hospitals met or outperformed facilities with lower ratings, with a few minor exceptions. The average SIR for CLABSI also shows the progress hospitals have made over the course of several years and reflect a dedicated effort to reduce infections on the part of hospitals and the CDC. However, while the SIR for CAUTI also shows a significant decrease, it’s unclear if the improvement is due to data collection differences between the Agency for Healthcare Research and Quality, which provided the above counts, and the CDC, which claims there has actually been a three to six percent increase in CAUTIs since 2009.

More quality differences emerge from updated point-of-care data. Again, while not all hospitals report scores for each measures, a few have data from close to two thirds or more of all hospitals with star ratings, allowing for some analysis.

Average SIR by HAI and Star Rating

Process of Care Measure Total 5 Star 4 Star 3 Star 2 Star 1 Star
Patients treated for blood clots on day of admission/surgery  93.8% 97.4% 95.6% 93.1% 93.0% 92.5%
Patients with blood clots who received two thinner drugs simultaneously  93.2% 95.2% 94.4% 93.1% 92.5% 91.2%
Stroke patients who received clot prevention treatment within 2 days of admission  96.5% 97.6% 97.3% 96.5% 95.8% 96.1%
Stroke patients needing cholesterol meds who received them before discharge  95.5% 97.6% 96.5% 95.25% 93.4% 95.0%
Patients suffering from chest pain/heart attack given aspirin within 24 hrs  96.12% 97.2% 96.8% 96.0% 95.4% 95.4%

Again, higher ranked hospitals had better scores, though in a few cases the difference was less than a percentage point. The greatest difference involved blood clots, which can be notoriously hard to detect in some patients and are often misdiagnosed.

Definitive Healthcare has the most up-to-date, comprehensive and integrated data on over 7,700 hospitals, 1.4 million physicians, and numerous other healthcare providers. Our database includes a wide variety of quality indicators, including star ratings, individual HCAHPS scores, VBP measures, and more.  Our database is updated with new quality data within days of it being released by CMS.

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