Quality Star Ratings on Medicare.gov
August 2015
2015 CMS National Training
Program Workshop
August 10 – 11
St. Louis, MO
Quality Star Ratings
Part of a larger effort at DHHS to transform
our health care system to deliver better care,
spend our dollars in a smarter way, and put
patients in the center of their care to keep
them healthy.
Pay providers for what works, unlock health
care data, and find new ways to coordinate
and integrate care to improve quality.
Quality Star Ratings
• Found on Medicare.gov
• Part of various provider “Compare”
websites
• First Quality Star Ratings appeared in
December 2008 on Nursing Home
Compare
Goal of Quality Star Ratings
Five-Star Quality Rating Systems have been
added to some of these sites, designed to:
• Give easy-to-understand summaries of
dimensions of provider quality;
• Help consumers make meaningful distinctions
between high- and low-performing providers
of care; and
• Be one tool among others to make informed
decisions about where to get health care.
• Help providers identify areas for improvement.
Goal of the QSR Websites
To help people make informed decisions
about where to get health care.
• Primary audience is the general
public.
• Secondary audiences include
providers, researchers, patient
advocates, discharge planners,
industry groups, media, etc.
Quality Star Ratings
on Medicare.gov
• Nursing Home Compare
• Hospital Compare
• Home Health Compare
• All Compare websites are moving
towards star ratings
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Nursing Home Compare Star Ratings
• The first, implemented in 2008, based on
three measures:
• Health Inspections
• Staffing
• Quality Measures
• Updated monthly
Nursing Home Compare Star Ratings
(1) Health Inspections Rating
• Based on State health inspections, both
annual and complaint
• More recent surveys are weighted more
heavily
• Based on relative performance within a state
Nursing Home Compare Star Ratings
Health Inspections Rating
Ratings determinations:
• The best 10% in each State receive a five-star
rating
• The middle 70% receive a rating of two,
three, or four stars, with an equal number,
approximately 23.33%, in each category
• The worst 20% receive a one-star rating.
Nursing Home Compare Star Ratings
(2) Staffing Rating – Based on two equallyweighted nurse staffing levels components:
• Registered nurse (RN hours per resident
day); and
• Total staffing ((RN + LPN + Nurse Aide
hours)/per resident day)
Nursing Home Compare Star Ratings
(3) Quality Measures Rating – Based residentlevel quality measures:
• Based on 11 of the 18 QMs currently posted
on the NH Compare website
• Data taken from mandated reporting of
clinical assessments
Nursing Home Compare Star Ratings
Quality Measures Rating
• Scores assigned to each QM and grouped
into quartiles
• All 11 QMs weighted equally to compile the
QM rating
• Five-Star rating is assigned using a set of
point thresholds
Nursing Home Compare Star Ratings
Overall Star-Rating is a composite of the three
dimensions
• The Health Inspection is the core rating; then
• Rate may be adjusted up or down based on
Staffing Rating; then
• Rate may be adjusted up or down based on
Quality Measures Rating
• Special Focus Facility – if not graduated,
maximum overall rating is 3 stars
Nursing Home Compare Star Ratings
Strengths and Limitations
• In-depth
• National measures – used in all nursing
homes
Limitations
• Self-reported data
• Represents only a few aspects of care
Hospital Compare Star Ratings
• First appeared April 16, 2015
• Updated quarterly
• Developed 12 Star Ratings based on
patients’ experiences to spotlight excellence
in healthcare quality.
• Based on HCAHPS (Hospital – Consumer
Assessment of Healthcare Providers and
Systems) survey data
Hospital Compare Star Ratings
HCAHPS Survey’s broad goals:
• Produce comparable data on the patient’s
perspective on care domains that are
important to consumers;
• Public reporting to create incentives for
hospitals to improve quality of care; and
• Public reporting to increase transparency of
hospital care provided.
Hospital Compare Star Ratings
Survey data used to report 11 measures on
Hospital Compare with each measure given a
Star Rating. A 12th Star Rating summarizes the
other 11 ratings. Measure topics include:
• Composite (7),
• Individual (2), and
• Global (2)
Hospital Compare Star Ratings
Composite Topics (7):
• Nurse communication
• Doctor communication
• Responsiveness of hospital staff
• Pain management
• Communication about medicines
• Discharge information
• Care transition
Hospital Compare Star Ratings
Individual Topics (2):
• Cleanliness of hospital environment
• Quietness of hospital environment
Global Topics (2):
• Overall rating of hospital
• Willingness to recommend hospital
Hospital Compare Star Ratings
• Summary Star Rating is an average of:
o Each Composite topic measure
o Single star for each Individual and Global topics
• Hospital must have 100 completed surveys
over 4-quarter period to get Star Rating
• <100 Data still reported publicly
Hospital Compare Star Ratings
CMS assigns 1, 2, 3, 4, or 5 whole stars for each
measure by applying statistical methods that
utilize relative distribution and clustering
• Clustering algorithm identifies gaps and
creates five categories such that hospitals
with scores with the same star rating are as
similar as possible and different star ratings
are as different as possible
HCAHPS Summary Star Ratings
April 2015
Star Rating
Number of Hospitals
Percentage
1
101
3%
2
582
16%
3
1414
40%
4
1205
34%
5
251
7%
3553
100%
Hospital Compare Star Ratings
Under Consideration
Overall Hospital Star Ratings
Currently in “Dry Run” to allow hospitals to
review the methodology and hospitals’ own
star rating based on April 2015 data.
Based on 75 existing quality measures.
Hospital Compare Star Ratings
Overall Hospital Quality Star Ratings
Seven Proposed Measure Groups
Outcome Measures:
• Mortality (6)
• Safety (8)
• Readmissions (7)
Patient Experience – (HCAHPS data-11)
Hospital Compare Star Ratings
Overall Hospital Quality Star Ratings
Proposed Measure Groups
Process Measures:
• Effectiveness (30)
• Timeliness (8)
Efficiency Measure:
• Imaging (5)
Home Health Compare Star Ratings
Quality Star Ratings added to Home Health
Compare (HHC) make information easier to use,
summarizing some of the current measures the
site already offers.
• First appeared July 16, 2015
• Updated quarterly
• An additional tool
• No current information is being removed
Home Health Compare Star Ratings
NEW NAME! Quality of Patient Care (QPC) Star
Rating
• Released July 16, 2015
• Formerly HHC Star Rating, changed to
distinguish it from Patient Survey Star Ratings
• Based on OASIS assessments and claims data
• Star Ratings based on 9 of the 29 currently
reported process and outcome quality
measures
Home Health Compare Star Ratings
QPC - Process Measures:
• Timely initiation of care
• Drug Education
• Current Influenza immunization
Home Health Compare Star Ratings
QPC - Outcome Measures, Improvement in:
• Ambulation;
• Bed transferring;
• Bathing;
• Pain interfering with activity; and
• Shortness of breath; also
• Acute care hospitalization
Home Health Compare Star Ratings
QPC Star Rating:
• Based on discharge data within the 12-month
reporting period;
• Initial ratings compared with and then
adjusted with all HHAs nationally;
• Adjusted ratings – assigned Star Ratings in 0.5
increments for each quality measure.
• Overall score for each HHA is an average of
each of the adjusted ratings between 1 & 5 with
0.5 increment.
Distribution of Quality of Patient Care
Star Ratings, July 2015
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Home Health Compare Star Ratings
New! Patient Survey Star Ratings
• Scheduled for publication on HHC starting
January 2016
• Based on HHCAHPS (Home Health –
Consumer Assessment of Healthcare Providers
and Systems) survey data based on the patient
experience of care measures
Dialysis Facility Compare
Quality Star Ratings added to Dialysis Facility
Compare make information easier to use,
summarizing some of the current measures
the site already offers.
• First appeared January 22, 2015
• Updated annually
• An additional tool
• No current information is being removed
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Dialysis Facility Compare
A single star rating is given to qualifying
facilities based on nine currently reported
quality measures grouped into three domains:
• Standardized Outcomes (hospitalization,
mortality, and transfusions) (3)
• Other Outcomes 1 (AV fistula, tunneled
catheter) (2)
• Other Outcomes 2 (Kt/V, hypercalcemia)
(4)
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Dialysis Facility Compare
• Each domain is scored between 0 – 100
• Final score is obtained as an average of the
three domain scores
– Facilities with the top 10% final scores were given a star rating of 5.
– Facilities with the next 20% highest final scores were given a star
rating of 4.
– Facilities within the middle 40% of final scores were given a star
rating of 3.
– Facilities with the next 20% lowest final scores were given a star
rating of 2.
– Facilities with the bottom 10% final scores were given a star rating
of 1.
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Physician Compare Quality Data
• Physician Compare now includes quality of
care performance scores for a small number
of group practices
– Released February 21, 2014
– Reports on 66 group practices and 141 ACOs
• Scores for individual health care
professionals will be added in the future
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Physician Compare Quality Data
Initial quality measures being added today include:
• Controlling blood sugar levels in patients with
diabetes.
• Controlling blood pressure in patients with
diabetes.
• Prescribing aspirin to patients with diabetes and
heart disease.
• Patients with diabetes who do not use tobacco.
• Prescribing medicine to improve the pumping
action of the heart in patients who have both heart
disease and certain other conditions.
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Quality Star Ratings - Resources
Medicare.gov
• https://www.medicare.gov/nursinghomecomp
are/About/What-Is-NHC.html
• http://www.medicare.gov/hospitalcompare/D
ata/HCAHPS-Star-Ratings.html
• https://www.medicare.gov/homehealthcompa
re/About/Patient-Care-Star-Ratings.html
• https://www.medicare.gov/dialysisfacilitycom
pare/#data/star-ratings-system
Quality Star Ratings
Thank you!
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