Star Ratings "Deeply Flawed," Offer Incomplete Picture of Hospital Performance

AAMC Urges Patients Not to Be Misled by Ratings

AAMC (Association of American Medical Colleges) President and CEO Darrell G. Kirch, MD, issued the following statement following the Centers for Medicare and Medicaid Services’ (CMS) release of the Hospital Compare Overall Hospital Quality Star Ratings:

“Patients should beware of making decisions about hospitals using the newly released star ratings. They are based on a deeply flawed methodology that does not take into account important differences in the patient populations and the complexity of conditions that teaching hospitals treat. As a result, many of the nation’s leading teaching hospitals—institutions that provide the most advanced health care in the world—have been assigned lower ratings than other hospitals that treat patients with less complex conditions or that treat only certain conditions. This new system could have very serious consequences for patients who are choosing where to go for treatment, potentially driving them away from some of the best hospitals for their conditions.

Through these star ratings, CMS has implied that hospitals have been measured on an equal basis and that the comparisons are fair, an assumption that is unfortunately not true. 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.

As a result, CMS used more than 60 measures to calculate ratings for teaching hospitals and as few as nine measures on some hospitals that treat patients with less complex conditions or that treat a limited number of conditions. AAMC analysis of the ratings has confirmed that the lower the number of measures a hospital reported, the more likely a hospital was to receive a higher star rating. In fact, hospitals that reported on only 60 percent of the metrics or less received almost half of the five-star ratings.

The AAMC and its member institutions strongly support providing transparent and meaningful information about hospitals for patients. However, we are extremely concerned about the potential consequences for patients that could result from portraying an overly simplistic picture of hospital quality with a star rating system that combines many complex factors and ignores the socio-demographic factors that have a real impact on health. Hospitals cannot be rated like movies.

Despite asking for ways to improve the methodology of the rating system, CMS failed to address concerns from both the hospital community and Congress, creating a system that is misleading and, ultimately, bad for patients. We urge CMS to re-do the star ratings to take into account socio-demographic status and the complex care provided by teaching hospitals. Only then can these ratings be meaningful to patients."

The Association of American Medical Colleges is a not-for-profit association dedicated to transforming health care through innovative medical education, cutting-edge patient care, and groundbreaking medical research. Its members are all 154 accredited U.S. and 17 accredited Canadian medical schools; nearly 400 major teaching hospitals and health systems, including 51 Department of Veterans Affairs medical centers; and more than 80 academic societies. Through these institutions and organizations, the AAMC serves the leaders of America’s medical schools and teaching hospitals and their more than 173,000 full-time faculty members, 89,000 medical students, 129,000 resident physicians, and more than 60,000 graduate students and postdoctoral researchers in the biomedical sciences.