Friday, 29 July 2016 14:38

How Many Stars Do You Have?

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To some, it may have felt like we were back in grade school, waiting to see how many gold stars we would get on the homework we turned in.

Well, hospitals, the waiting is over. 

On July 27, the Centers for Medicare & Medicaid Services (CMS) released its hospital star ratings, despite pushback from many in the healthcare industry. Much of the pushback has centered on the belief that the star rating system is flawed, in that it does not take into account factors such as socioeconomic status and patients with multiple and complex conditions. In addition, hospitals are concerned that consumers may not truly understand the rating system limitations and that many factors should be evaluated when deciding on where to seek care, not only this one system.

The ratings reported for 4,599 hospitals were:

  • Five Stars:  2.2 percent
  • Four Stars:  20.3 percent
  • Three Stars:  38.5 percent
  • Two Stars:  15.7 percent
  • One Star:  2.9 percent

Safety net hospitals received slightly lower ratings, and some smaller hospitals were ineligible for reporting, as they did not have the data to report due to their small size.

So, what does this mean for hospitals? We have to remember that these ratings are based on data collected two years ago, so it is old data already. And while we may not all agree on the star ratings, it is what we have right now, so it is important that we take it seriously while continuing to provide input to CMS to improve the system as we move forward. Our best offense and defense is knowing where we stand on each measure so that we can focus on where to improve.

Data is the key element in analyzing outcomes. Basically, the data will let you know if you are experiencing success, and where you may need to focus on improvements. It will also determine how other organizations interpret what you are doing and how, as well as how you appear to your patients. You will want to ensure that medical record documentation is complete, as that will impact HIM (health information management) code assignment and quality abstracted data that is reported to various organizations. Patient experience data is also important to analyze how consumers view us – which may be very different from how we view ourselves. A list of the measures is provided at the end of this article.

In today’s healthcare environment, we must learn to do more with less, so whenever we can leverage technology to assist us, we should. Documentation is a good place to start, so be sure that your EHRs (electronic health records) are appropriately set up, especially across different patient care settings and services. Good data collection/reporting software to help ensure that accurate data is collected and transferred is also very important.

Ensure that optimal processes are established for quality data collection, internal reconciliation, monitoring, and reporting. This initiative should be led by the C-suite, with a strong organizational chart to ensure that all the players are identified, with expectations set for all roles.

Finally, it will be important to monitor how you are doing from both a patient outcomes/quality and financial perspective. Communication to the team will be important so that adjustments can be made in a timely manner.


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Last modified on Friday, 29 July 2016 15:23