Though the federal government hopes its Hospital Compare website will lead people to research before choosing a facility, the Medicare Payment Advisory Commission last week said users should hold off of drawing hospital comparisons based on the site's star ratings data.
In a letter to the Centers for Medicare and Medicaid Services, MedPAC took issue with several discrepancies in the Hospital Star Rating program and asked the federal agency to continue to refine the program.
[Also: Full list: See how hospitals scored in the new Overall Star Ratings from CMS]
"The Commission is concerned that the current Hospital Star Rating program may not fully account for differences in the intrinsic health risks that patients bring to hospitals, and therefore may not produce a true 'apples-to-apples' comparison," the group said.
For example, MedPAC's analysis found that one-star hospitals saw an average of 78 percent of admissions through emergency departments, while for five-star hospitals, ED admissions were closer to 36 percent. That suggests one-star hospitals dealt with a greater percentage of potentially complicated and severe cases, which can affect outcomes.
[Also: Quantros study challenges reliability of CMS hospital star ratings]
As it stands, the ratings program grades hospitals on seven quality measure groups, with the first four -- mortality, readmissions, patient safety and patient experience -- weighted higher since they deal with outcomes. But MedPAC said only 57 percent of five-star hospitals disclosed data on all four outcome groups while one-star hospitals almost unanimously were rated on data for all four. That suggests there could be an advantage to having missing data, MedPAC said.
CMS released its first batch of overall star ratings in July, and only 102 hospitals earned five stars. Meanwhile, 129 hospitals earned one star.
CMS has already faced criticism, and even Congressional requests to delay releasing the ratings, over similar concerns. One of the biggest issues, many claim, is that the lack of an adjustment for socioeconomic conditions in the hospital ratings means facilities in poorer areas, or in areas where language barriers could create communication issues, will have a harder time scoring high ratings.
In addition to its concerns over star rating comparisons, MedPAC also said the new system is unnecessary since it overlaps with existing reporting programs.
[Also: See how CMS 5-star hospitals stack up in other ratings programs]
"Although the Hospital Star Rating program uses metrics that hospitals are already reporting to CMS, it represents a new organization of the scoring methodology for CMS to administer and for hospitals to track," the group said.
MedPAC, an independent federal body that reports to Congress on Medicare administration, said it would be better if CMS aligned its rating methodology with the value-based purchasing program, which pays incentives or levies fines against hospitals based on quality data.