Feds Raise Rating Scores for IL Hospitals, But Controversy Persists

Twenty-one Illinois hospitals received a five-star rating in the latest Centers for Medicare and Medicaid Services (CMS) ratings, but questions linger on the methodology used to rate the hospitals.

Some of the Illinois hospitals receiving five star ratings are: Rush University Medical Center, up from four last year, Advocate Lutheran General Hospital, Alexian Brothers Medical Center 1, Delnor Community Hospital and Edward Hospital.

Other hospitals with five-star ratings are: Northwestern Medicine, McHenry Hospital, OSF Saint Paul Medical Center, Rush Oak Hospital, Valley West Community Hospital and Wabash General Hospital 1 among others.

The Chicago Tribune reported that the University of Chicago Medical Center earned three out of five stars for quality, up from two last year and Northwestern Memorial Hospital earned four stars, up from three last year.

Nine Illinois hospitals received the poorest grade of one star each in ratings that are often criticized for being tough on hospitals in poor areas, where many patients may need to be readmitted because they lack the resources at home to properly recover.

Mount Sinai, one of the hospitals that received a one-star rating, charged that most of the data CMS used to compile their ratings were two to three years old and that during that time, the institution had improved in several areas.

How the rating system is conducted

This year, CMS evaluated 4,586 hospitals nationwide.  Hospitals were graded on 116 different criteria. A total of 986 hospitals were not assigned ratings.

The criteria cover hospital practices such as after-care outcomes, billing accuracy, internal communication and quality of medical care. The ratings also include patient experience surveys, complications, deaths and readmission rates, among others.

Rating system faces criticism

Since its introduction in 2005, the rating system has received some criticism, particularly from the American Health Association (AHA), which has urged CMS to take down the ratings until the agency implements long-term changes to the methodology it uses for the ratings.

“We strongly believe that [the] re-publication of the flawed and misleading ratings do not advance the goal of providing the public with accurate, purposeful information about the quality of care,” Tom Nickels, AHA Executive Vice President, said.

AHA has previously described the rating system as “inaccurate, misleading comparisons of quality performance.” It has advised CMS not to “refresh the ratings until those improvements have been vetted and are ready for implementation.”

Last August, CMS announced that it planned to change the methodology it used in coming up with ratings after facing much criticism from the healthcare industry, which felt it was flawed and needed a revamp.

Seema Verma, a CMS administrator, defended the rating system, arguing that they used the “existing methodology to ensure patients have the information they need. The American people deserve up-to-date information on how hospitals are performing.”

In a blogpost, Verma wrote that CMS would update the star rating methodology through rulemaking this year based on feedback they were receiving. The feedback will shape the methodology proposals CMS plans to include in the Fiscal Year 2021 Hospital Inpatient Prospective Payment System proposed rule, which will be issued in spring 2020.

Hospital ratings are quite a contentious issue. Two other rankings used to grade hospitals can be found at the U.S. News & World Report Best Hospitals Honor Roll and Leapfrog Group.

In 2018, Rush University Medical Center published its own research on hospital ratings, which ranked 70 hospitals across the country based on combined ratings from five major groups. It takes into account how consistently the hospitals perform across all those groups, the Chicago Tribune reported.

In a statement following the latest CMS ratings, Rush University Medical Center said its Chief Executive Officer, Omar Lateef, Bala Hota, their chief analytics officer, and Thomas Webb, associate vice president for quality analytics, performed an in-depth analysis of CMS methodology. Their findings were that CMS used a complex statistical model that put tremendous weight on small, often insignificant numbers of events, resulting in downgrading academic and other larger medical centers that treat medically complex patients, as well as patients with socioeconomic issues who are more likely to be readmitted.

“We want to focus on the measurements that are the most meaningful in tracking patient outcomes and experience. This is about doing what is best for the patient. We are hoping to continue working with rating organizations to create meaningful measures that help patients find the care they are looking for and provide valuable data for hospitals to guide internal improvement,” Lateef said.