Despite strong objections from safety net and teaching hospitals and some members of Congress, federal health officials on Wednesday released the long-anticipated for 4,600 hospitals.
The ratings, which score hospitals with one to five stars, dinged 133 hospitals with a single star while awarding five stars to 102 hospitals.
Scores were based on 62 quality measures such as rates of infections, readmissions, emergency room wait times, and potentially inappropriate use of CT imaging.
In its release, the Centers for Medicare & Medicaid Services (CMS) said that having a single star rating for each hospital makes "it easier for consumers to compare hospitals and interpret complex quality information."
This new star system is a major expansion of the agency's current rating program, which began in spring of 2015 and assigned hospitals one to five stars based only on surveyed patients' responses about their hospital experience. The expanded program was scheduled for release in April but because of numerous objections, was postponed.
But America's Essential Hospitals, which represents healthcare facilities with larger percentages of lower socioeconomic populations, that the CMS scoring system unfairly punishes hospitals treating larger percentages of the underserved and disadvantaged patients for factors beyond their control, such as levels of community support for patients after their hospital discharge or their general health status.
"We're not against the star ratings," said Beth Feldpush, the organization's senior vice president for policy and advocacy, said in an interview last week. "But we want to make sure the individual measures that feed into the star ratings are properly adjusted for, to make sure that socio-demographic factors are properly accounted for."
Based on how safety net versus non-safety net hospitals stack up, she said, the rating system appears unfair.
The Association of American Medical Colleges the star system "deeply flawed," saying in a news release that it unfairly gives many teaching hospitals lower scores.
"Teaching hospitals perform a wide array of complicated and common procedures, pioneer new treatments, and care for broader socio-demographic patient populations that may not have access to regular care. Yet under the new ratings, they are compared directly to hospitals with more homogenous patient populations and hospitals that do not do enough procedures to be counted," the AAMC said.
CMS, however, said previously in its rule-making documents that, because many hospitals with a disproportionate share of low-income patients and many teaching hospitals do get high scores in all of the measures used in the algorithm, it would be wrong to have separate scoring systems, one for safety net and teaching hospitals and another for the rest.
The agency said, in effect, that it would be like saying it was OK for teaching, safety net, or disproportionate-share hospitals to get a pass for providing a lower quality of care.
A showed distributions of star ratings by various hospital classifications. Seven safety net hospitals (0.5% of all such facilities) received five stars whereas 183 (13.7%) received four stars.
In contrast, 90 (2.8%) of non-safety net hospitals received five stars and 742 (23.2%) received four stars. Teaching hospitals showed a similar proportion of high ratings.
"If you don't appropriately account for community level factors in the measure, what we are now perpetuating is a two-tiered system," Feldpush said. "That's because no hospital wants to provide access to the market in a community when you know, no matter how well of a job you're going to do there, the cards are stacked against you when these report cards come out."
She added that the star ratings are having a negative impact on providers at safety net hospitals. "Certainly, most people who work in them think that if you get a grade you don't think reflected your performance, you're probably going to be upset about it."
"There's growing evidence showing that social and community level factors -- whether it's low income or low education -- have an impact on healthcare utilization and health status across a lifetime," Feldpush said. She also referred to a recent documenting those impacts.
In letters this spring, members of the House and Senate urged CMS to delay the star ratings release until questions about the algorithm can be studied and their fairness ascertained. On July 25, Rep. James Renacci (R-Ohio), introduced a that would require CMS to delay the star ratings rollout for one year.