The Ins and Outs of Hospital Quality Star Ratings

The next round of hospital Star Ratings will be issued in early 2020 – just around the corner. Additionally, after the Overall Hospital Quality Star Ratings came under scrutiny in 2018 for its methodology, the Centers for Medicare & Medicaid Services (CMS) sought public input and began working toward a new methodology that may be reflected in 2021.

Because Star Ratings are publicly reported and consumers use them to evaluate hospitals, providers take these measures seriously. Star Ratings go beyond the Leapfrog measures, which focus on safety alone, to evaluate overall performance.

Don’t let current-day lapses affect future ratings.

It’s important to remember that Star Ratings lag hospital performance by about two years, meaning current-day performance is not necessarily reflected. This is a key message to reiterate to the board of directors and the public - it's critical to sustain results so that current-day lapses don't affect future ratings.

High Star Ratings are the result of highly reliable, optimized care delivery. The Star Ratings system heavily weights four categories to calculate the total grade. Readmissions, mortality, safety and patient experience are weighted at 22 percent each. Key to success is a dashboard, such as Star Watch, which aggregates these program measures in one place so providers can easily evaluate opportunity areas based on industry benchmarks.

Providers must ensure daily prioritization and performance improvement across all four Star Ratings categories.

Here’s how high-performing Premier® members are doing so:

• Readmissions. Hospitals that reduce readmissions live and breathe their data.
  
  These organizations often use readmission risk tools to slice their data in multiple ways (whether by payer, age, physician or diagnosis). In doing so, they can understand the root cause of the problem, including social determinants of health and community health effects on patients, and begin to implement fixes.
  
  Clinical decision support (CDS) tools, which intervene at the point of provider decision-making with evidence-based insights, are another solution in a provider’s toolkit for readmission reduction. One study showed that when a provider adheres to all CDS recommendations, the odds of a readmissoin decrease.
  
  While it’s tempting to put readmissions work on the backburner because the fee-for-service model incentivizes volume, operators must remember how readmissions reduction will reverberate across alternative payment models, quality ratings and patient experience.

• Mortality. CMS calculates its mortality score based on populations of patients diagnosed with chronic obstructive pulmonary disease (COPD), heart failure, pneumonia, coronary artery bypass graft and stroke. Providers can make headway with at least two of these populations – COPD and heart failure – by ensuring a strong strategy to care for patients with chronic conditions.
  
  COPD and heart failure are among six prevalent chronic conditions that contribute to the majority of U.S. healthcare spending, and research shows that more preventative and proactive care can help avert disease progression and escalation of care, including unnecessary utilization of the emergency department.

• Safety of Care. Zero harm and highly reliable care begin with robust business intelligence, predictive technology and a culture that rewards collaboration.
  
  Hartford Health Care, a six-hospital system in Connecticut, did just that when it decreased its serious safety events by 70 percent by focusing on culture at the same time as safety, enabling the work to spread smoothly from the facility level to systemwide. Hartford also found valuable time savings to the tune of 10 hours a week when the system implemented clinical surveillance technology to automate electronic surveillance of healthcare-associated infections.
  
  Successful high-reliability organizations implement training programs and promote a culture of improvement that encourages communication and teamwork to empower staff.

• Patient Experience. The transition to value-based care places patients in the middle of the care equation.
  
  Patient experience will continue to be built on the foundation of personal interactions with care providers and staff, but progressive organizations recognize that patient experience must also encompass how the patient perceives the episode as a whole. This is even more important as new consumer-centric healthcare competitors enter the marketplace.
  
  Providers should think holistically about the care patients receive and move toward models that incentivize sustainable, cost-effective outcomes for both the provider and patient.

Now more than ever, executives need to have a solid understanding of organizational performance.

With CMS adjusting its methodology and updating Star Ratings intermittently, it’s even more important for executives to have a strong idea of how their organizations are trending so they can celebrate progress or course-correct as necessary.

Providers should be capable of coalescing Hospital Compare program measures in one dashboard so hospitals can measure their performance to benchmarks with relevant comparators and confidently estimate their Star Ratings. With this business intelligence in hand, providers can target measures where performance gaps and failures are occurring; develop sustainable programs through the continuous monitoring of performance improvement efforts; and streamline efforts around quality reporting requirements and be back on track in a timely manner.

These four areas take time and commitment from stakeholders across the organization to achieve results. Working with a care partner can help accelerate those changes, both from a strategic goal-setting perspective, as well as a boots on the ground to implement improvement.

Learn more about how to elevate performance in the Overall Hospital Quality Star Ratings.