The Definitive Blog

Star Ratings vs. Network Structure: Which is More Important?

CMS recently announced that they would be postponing the release of their new star ratings for hospitals until July of this year. The new ratings, which incorporate quality measures in addition to the patient experience scores included in the previous ratings, were scheduled to be released to the public this past week but due to a flood of concerns regarding the legitimacy and accuracy of these quality scores, CMS plans to withhold them for the time being to work through any questions surrounding how these scores are calculated.

Many hospitals and health systems voiced their concerns over several perceived flaws in the methodology as well as the lack of details given to providers. Just last year only 251 hospitals of a total of 3,500 that were rated received a five star rating under the patient satisfaction measures. Many providers are claiming that CMS is oversimplifying the complexity of delivering high-quality care. One way in which some argue that CMS’ quality scores oversimplify is by not taking many socio-economic factors into consideration.

There are a number of different providers, including academic or teaching hospitals, that may be treating lower-middle class patients, which may put these hospitals at an unfair disadvantage. Poorer patients tend to have more complex medical needs due to their lack of medical care so ratings may be lower for providers treating this patient population. Providers are also concerned these ratings put too much weight on patient satisfaction data. Some of the other 62 quality measures in the CMS reports include mortality, safety, timeliness and effectiveness of care, and hospital readmissions.

The additional time CMS is providing to review these quality measures is definitely necessary but may not be the end all solution for the issues within the scope of patient care across the healthcare system. There is no correct way to collect quality measures. CMS did not create this program, as Physician Regional spokeswoman Marti Van Veen puts it “to provide a single, methodologically sound representation of hospital quality but rather to meet specific legislated program needs or research purposes.”

The quality measure CMS has created is only one way to get a quick glimpse into patient care at individual hospitals. The last few years, there has been an increased push to provide greater quality care across the board, but these quality measures are not the sole deciding factor on whether or not a hospital is going to succeed in this area. In fact, hospitals and other inpatient providers may need to begin to think about switching the entire way their network is organized.

 

Patient Survey HCAHPS Surrmary Start Rating

 

The need for a stronger more integrated hospital network is becoming more apparent. Just take a look at the MedPAC analysis which illustrates that inpatient volume across hospitals is down 6% from 2010 to 2013, while the outpatient side of things has been steadily on the rise and has had a 30% increase in the last 13 years. Interpretation of these numbers suggests patients are looking at providers other than traditional hospitals for their medical needs.

While this does initially seem like a threat to hospitals, it may actually be a great opportunity for the future of healthcare to deliver better, more desired patient care. To do this, hospitals must redefine themselves and coordinate care rather than just deliver it.

Patients need to be at the forefront of healthcare, and it seems as though many quality and value based purchasing program may be hindering this move rather than helping. Hospitals’ accomplishments depend on how they interact with other players and providers in the market; the main goal should not be to just fill as many beds as possible. Jonathan Bush, CEO of Athenahealth, outlined five core competencies that successful hospitals will need to embrace:

  • Leverage a foundation of cross-continuum connectedness. Developing stronger relationships and building a network that works with ease across all healthcare categories including costs, quality, and technology will be key.
  • Create savvier marketing techniques to stand out by understanding consumers and what their needs are.
  • Work with different employers and insurers to make sure patients are coming into each facility for services they do really well rather than trying to cover all possible services at once.
  • Have more accessibility, which will include providing mobile application to easily schedule appointments and not just that, but provide multiple options for multiple procedures.
  • Be part of an integrated network. This simply means, eliminating services that can be performed at a primary care practice or clinic and exporting any non-invasive surgeries to more cost-efficient outpatient facilities.

Hospitals seem to be up in arms about CMS’ quality scores, but the reality of the situation is that there will not be a perfect way to calculate quality measures to include every possible factor. CMS provides these scores more for research purposes and to provide a quick snapshot of the quality of care for each individual facility. If hospitals are concerned with providing better, more efficient patient care, working towards a more integrated network of both outpatient and inpatient facilities to deliver the best possible services and create ease of access is the best option for the success of the healthcare system.

Definitive Healthcare has the most up-to-date, comprehensive and integrated data on hospitals, physicians and other healthcare providers. Our hospital database tracks nearly 7,600 US hospitals and includes HCAHPS scores and other quality metrics.

April 26, 2016