Quality Star Ratings on Medicare.gov
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1 Quality Star Ratings on Medicare.gov August CMS National Training Program Workshop August St. Louis, MO
2 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.
3 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
4 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.
5 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.
6 Quality Star Ratings on Medicare.gov Nursing Home Compare Hospital Compare Home Health Compare All Compare websites are moving towards star ratings 6
7 Nursing Home Compare Star Ratings The first, implemented in 2008, based on three measures: Health Inspections Staffing Quality Measures Updated monthly
8 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
9 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.
10 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)
11 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
12 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
13 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
14 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
15 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
16 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.
17 Hospital Compare Star Ratings Survey data used to report 11 measures on Hospital Compare with each measure given a Star Rating. A 12 th Star Rating summarizes the other 11 ratings. Measure topics include: Composite (7), Individual (2), and Global (2)
18 Hospital Compare Star Ratings Composite Topics (7): Nurse communication Doctor communication Responsiveness of hospital staff Pain management Communication about medicines Discharge information Care transition
19 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
20 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
21 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
22 HCAHPS Summary Star Ratings April 2015 Star Rating Number of Hospitals Percentage % % % % % %
23 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.
24 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)
25 Hospital Compare Star Ratings Overall Hospital Quality Star Ratings Proposed Measure Groups Process Measures: Effectiveness (30) Timeliness (8) Efficiency Measure: Imaging (5)
26 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
27 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
28 Home Health Compare Star Ratings QPC - Process Measures: Timely initiation of care Drug Education Current Influenza immunization
29 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
30 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.
31 Distribution of Quality of Patient Care Star Ratings, July
32 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
33 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 33
34 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) 34
35 Dialysis Facility Compare Each domain is scored between 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. 35
36 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 36
37 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. 37
38 Quality Star Ratings - Resources Medicare.gov are/about/what-is-nhc.html ata/hcahps-star-ratings.html re/about/patient-care-star-ratings.html pare/#data/star-ratings-system
39 Quality Star Ratings Thank you! 39
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