o 2022 - First Star Ratings refresh impacted by CMS COVID-19 exception (v4.1) 4/24/2023. One-half of the contract-level median and the contract-level median enrollment percentages are assessed separately for contracts that offer Part C and stand-alone Part D contracts. For patients making a choice for a specific medical condition or health care need: The CMS Overall Hospital Quality Star Ratings1 (referred to subsequently as the Star Ratings) were created to provide consumers with a simple, easy-to-understand summary of the measures available in the Hospital Compare measure set.2 Under the current method, a set of 57 individual measures of quality are categorized into 7 quality groups or domains. One characteristic of those hospitals is that they report on relatively fewer measures and do not have scores in all quality groups, including the important quality groups of Safety of Care and Mortality.19. CMS creates the overall star rating for nursing homes from 3 parts: 1.) Papageorge MV, Resio BJ, Monsalve AF, et al. Home Health Star Ratings | CMS Objectives: To examine characteristics of the CMS Overall Hospital Quality Star Ratings related to their use by consumers for choosing hospitals. In deciding whether to include the improvement measures in a contract's highest and summary rating(s), CMS applies the following rules: (i) For MAPDs and PDPs, a comparison of the highest rating with and without the improvement measure is done. (i) Improvement measures receive the highest weight of 5. Since highly-rated contracts may have the improvement measure(s) excluded in the determination of their final highest rating, each contract's weighted variance and weighted mean will be calculated both with and without the improvement measures. Accessed May4, 2020. https://health.data.ny.gov/Health/Hospital-Acquired-Infections-Beginning-2008/utrt-zdsi, 17. (3) Health equity index. 2016;315(21):2265-2266. doi:10.1001/jama.2016.5638, 3. ), Additional data in the quality domains of mortality and surgical site infection (SSI) were obtained from California and New York. Subject to paragraphs (e)(2) and (3) of this section, CMS will assign weights to measures based on their categorization as follows. Measure scores are converted to a 5-star scale ranging from 1 (worst rating) to 5 (best rating), with whole star increments for the cut points. Use the navigation links in the gray bar above to view the table of contents that this content belongs to. Second, in the state-level analysis, some member hospitals in multihospital health systems reported their quality data for Star Ratings in a consolidated way under the same CMS Certification Number. (C) A contract with low variance and a relatively high mean will have a reward factor equal to 0.2. NEJM Catalyst. doi:10.1093/jncics/pkaa059, 11. The Office of the Federal Register publishes documents on behalf of Federal agencies but does not have any authority over their programs. Understanding the relationship between the Centers for Medicare and Medicaid Services Hospital Compare star rating, surgical case volume, and short-term outcomes after major cancer surgery. CMS just gave 400+ hospitals five stars. See how yours fared. - Advisory The Cost-Saving Benefits of Direct-to-Consumer Telehealth for Employees. The Fundamentals of Medicare Advantage Star Rating Methodology Title 42 was last amended 6/13/2023. However, plans need to carefully review every rate and respond to CMS within the specified time frame if discrepancies are discovered. Starting with the 2026 Star Ratings and subsequent Star Ratings years, patient experience and complaint measures receive a weight of 2. (iii) The Star Ratings measures that remain after the exclusion criteria, paragraph (f)(2)(ii) of this section, have been applied will be adjusted for the determination of the CAI. 16, 2018, as amended at 84 FR 15842, Apr. All concerns over the validity of a result should be contested as part of the First Plan Preview. We recommend you directly contact the agency associated with the content in question. J Am Coll Cardiol. All 3 of those measures were for care related to CRE. (ii) The Part C and D improvement measures are not included in the count of measures needed for the overall rating. (v) The rating-specific CAI values will be determined using the mean differences between the adjusted and unadjusted Star Ratings (overall, Part D summary for MAPDs and Part D summary for PDPs) in each final adjustment category. (ii) Relative performance of the weighted variance (or weighted variance ranking) will be categorized as being high (at or above 70th percentile), medium (between the 30th and 69th percentile) or low (below the 30th percentile). (iii) The combination of the relative variance and relative mean is used to determine the reward factor to be added to the contract's summary and overall ratings as follows: (A) A contract with low variance and a high mean will have a reward factor equal to 0.4. CMS releases the 2021 hospital star ratings - HFMA (6) Missing data. (3) New measure adjustments. Austin JM, Derk JM, Kachalia A, Pronovost PJ. HPR and Star Ratings share some areas, but Star Ratings include additional areas (Table 1). This year's refresh will incorporate data from 2021 Hospital-Specific Reports - Centers for Medicare & Medicaid Services For 2018 star ratings, CMS derived MA-PD star ratings from a . Ann Surg Oncol. Quality measures and 3.) The study in JAMA Network . CMS assigns the overall star rating in these steps: Castellucci M. CMS unveils updated hospital star ratings formula. The only relationship that was found in the adjusted analysis (craniotomy mortality in New York) showed an interesting pattern in which the lowest mortality was found in 3-star hospitals rather than in 4- or 5-star hospitals. CMS has been making changes to different components of the methods over the years, however, trying to flatten the distribution bell curve and assign more hospitals in the 1-star and 5-star categories.17. Effective for the Star Ratings issued in October 2023 and subsequent years, prior to applying mean resampling with hierarchal clustering, Tukey outer fence outliers are removed. (eg: An overall rating that brings together scores on multiple individual measures of quality simplifies the decision about inclusion in the network, and it allows a plan or purchaser or patient advocacy group to make recommendations to its members or clients about good vs bad hospitals for purposes of their choices.6. 13. (2) The Part D summary rating for MAPDs will include the Part D improvement measure. (4) Other Star Ratings measure adjustments. will bring you directly to the content. This contact form is only for website help or website suggestions. (1) Cut points. (B) The initial categories are created using all groups formed by the initial LIS/DE and disabled groups. This month, the Centers for Medicare & Medicaid Services (CMS) will refresh the Overall Hospital Quality Star Ratings (Overall Star Rating) on its Care Compare website, the second update since the agency overhauled the methodology in 2020. In deciding whether to include the improvement measures in a contract's final highest rating, CMS applies the following rules: (i) If the highest rating for each contract-type is 4 stars or more without the use of the improvement measure(s) and with all applicable adjustments (CAI and the reward factor), a comparison of the highest rating with and without the improvement measure(s) is done. Jul 27, 2022 - 03:32 PM The Centers for Medicare & Medicaid Services today updated with 2021 data the Overall Hospital Quality Star Ratings at its Care Compare website and Provider Data Catalog. The results of a similar analysis at the individual measure level are shown in Figure 2. (iii) Through the 2025 Star Ratings, patient experience and complaint measures receive a weight of 4. (iii) As specified in paragraphs (i)(2) through (8) of this section, a certain minimum percentage (25 percent or 60 percent) of the enrollees under the contract must reside in a Federal Emergency Management Agency (FEMA)-designated Individual Assistance area at the time of the extreme and uncontrollable circumstance. developer resources. PDF NCQA Health Plan Ratings vs. Medicare Part C and Part D Star Ratings For example, if a hospital had the best score in all 7 groups, it would receive the high benchmark score. (B) The adjusted measure scores are converted to a measure-level Star Rating using the measure thresholds for the Star Ratings year that corresponds to the measurement period of the data employed for the CAI determination. Share. July 2023 release may represent a "new normal" for Star Ratings. Cost-effectiveness of Total State Coverage for Hepatitis C Medications, Letter From the Editorial Board: Jan E. Berger, MD, MJ, Value-Based Management of Specialty Drugs: Practical Considerations and Implications for Pharmacy, Influence of Health Care Systems on Mortality in Adult Patients With Cancer, US Cost-effectiveness and Budget Impact of Point-of-Care NAAT for Streptococcus, Properties of the Overall Hospital Star Ratings and Consumer Choice, Variability of COPD Inhaler Coverage in Medicare Part D, Timely Preterm-Birth Prediction Among Pregnant Women in Medicaid Without Preterm-Birth History, Association Between Interhospital Care Fragmentation, Readmission Diagnosis, and Outcomes, Standardized Total Knee Arthroplasty Pathway Improves Outcomes in Minority Patients. Previously, CMS calculated its star ratings using a method called a latent variable model, which uses a variety of variables to calculate the weight of each measure used in the ratings. Typically, at the same time of the First Plan Preview, compliance officers will receive a CAHPS report. For example, Star Ratings seemed to be significantly associated with cancer surgery outcomes,8-10 although the efficiency, effectiveness, and feasibility of patients use of Star Ratings to identify high-quality hospitals for complex cancer surgeries was questioned.10 On the other hand, no significant associations were found between Star Ratings and mortality in laparoscopic abdominal surgeries, serious morbidity for bariatric or hiatal hernia surgeries, or 30-day risk-standardized mortality after PCI. California hospital networks are narrower in Marketplace than in commercial plans, but access and quality are similar. No hospital is ranked in the worst-performing quartile or subject to the 1-percent payment reduction. 2018;28(6):486-494. doi:10.1136/bmjqs-2018-008384, 5. App Adapted for Anorexia Nervosa Could Strengthen Recovery, Prevent Relapse. "Published Edition". CMS. If the contract had any combination of Part C or Part D summary ratings of 2.5 or lower in all 3 years of data, it is marked with a low performing icon. 2018;71(suppl 11):A95. (iv) For an affected contract with at least 25 percent of enrollees in FEMA-designated Individual Assistance areas at the time of the extreme and uncontrollable circumstance, the contract receives the higher of the previous year's Star Rating or the current year's Star Rating (and corresponding measure score) for each CAHPS measure. Please do not provide confidential (iv) The reward factor is determined and applied before application of the CAI adjustment under paragraph (f)(2) of this section; the reward factor is based on unadjusted scores. BMJ Qual Saf. A contract that meets all of the following criteria is an affected contract: (i) The contract's service area is within an emergency area during an emergency period as defined in section 1135(g) of the Act. Seven measures that could not be categorized into quartiles due to their distributions (HAI-4, OP-4, OP-30, OP-33, OP-11, PC-01, and VTE-6, defined in eAppendixA) were excluded. (iii) The provisions of 423.184(g)(2) are not applied for failure to submit CAHPS-based measures. If you have comments or suggestions on how to improve the www.ecfr.gov website or have questions about using www.ecfr.gov, please choose the 'Website Feedback' button below. This content is from the eCFR and is authoritative but unofficial. This will be the first opportunity to see the case-mix adjusted CAHPS rates along with the actual Star Rating ascribed to each measure. The contract's stability of performance will be assessed using the weighted variance and its ranking relative to all rated contracts in the rating type (overall for MAPDs and Part D summary for MAPDs and PDPs). National Quality Forum. 2021 Star Ratings Data Table (Oct 08 2020) (ZIP) 2021 CAI Measure Selection Supplement (PDF) 2020_Display_Measures_2020_01_10_2 (ZIP) Star Ratings Technical Notes (Oct 10 2019) (PDF) 2020 Star Ratings Fact Sheet (PDF) 2020 Star Ratings Data Table (Oct 21 2019) (ZIP) 2020 CAI Measure Selection Supplement (PDF) The 2023 release of the Medicare Star Ratings is just around the corner. (B) To determine a contract's final adjustment category, contract enrollment is determined using enrollment data for the month of December for the measurement period of the Star Ratings year. File Name File Type File Size : Action; April 2021 Overall Hospital Quality Star Rating Mock HSR (02/01/2021) An example of the HSR sent to hospitals, as part of the preview period for the April 2021 public reporting of the Overall Hospital Quality Star Ratings. Jul 14, 2022 - 08:20 AM by John Allison , Akin Demehin In 2020, the Centers for Medicare & Medicaid Services (CMS) overhauled the Hospital Overall Quality Star Ratings methodology with the expressed purpose of making ratings more transparent, equitable, stable and predictable. HHCAHPS star ratings. However, the extent to which the curve is compressed within the potential range of scores vs spread across that whole range would not seem to be an intentional design feature, as a wider distribution across the full possible scale range would be more useful for consumer choice. Of the 14 measures available for New York, there were 5 significant associations in the unadjusted values; 3 were still significant in the adjusted analyses. We find, however, that many 1-star hospitals have top scores in important areas such as Safety of Care, Mortality, or Patient Experience. Beginning with the August 2022 refresh of Care Compare, a Family Caregiver Survey Rating summary Star Rating will be publicly reported for all hospices with 75 or more completed surveys over the reporting period. (h) Posting and display of ratings. (iv) When a contract is an affected contract with at least 25 percent of enrollees in FEMA-designated Individual Assistance areas at the time of the extreme and uncontrollable circumstance with regard to separate extreme and uncontrollable circumstances that begin in successive years, it is a multiple year-affected contract. The higher rating is used for the summary rating. To what extent do the Star Ratings predict measures of quality for specific clinical programs or services that are not represented in the Star Ratings but might be relevant to patient decisions about where to seek care. CMS will list the CMS PSI 90 composite value and measure scores as "N/A" and the Total HAC Score as "0.0000" in the Provider Data Catalog. The Medicare enrollment data would be aggregated from MA contracts that had at least 90 percent of their enrolled beneficiaries with mailing addresses in the 10 highest poverty states. The low performing icon is calculated by evaluating the Part C and Part D summary ratings for the current year and the past 2 years. Study Design: Observational study using secondary dataanalyses. Organization and Purpose (2) Rules for new measures. (3) For 2022 Star Ratings only, CMS runs the calculations twice for the highest rating for each contract-type (overall rating for MAPD contracts and Part D summary rating for PDPs) and Part D summary rating for MAPDs with all applicable adjustments (CAI and the reward factor), once including the improvement measure(s) and once without including the improvement measure(s). Association between New York State hospital post-percutaneous coronary intervention mortality and readmissions and CMS Hospital Star Ratings. will also bring you to search results. (i) A contract must have scores for at least 50 percent of the measures required to be reported for that contract type for that domain to have a domain rating calculated. Because the overall Star Ratings are not correlated with other quality measures for specific clinical conditions or procedures, the global Star Ratings may not provide useful guidance to consumers for choices of their specific medical conditions or needs. Contact Cynthia Pawley-Martin for strategic insights to ensure Star Ratings success. Our study had limitations. (i) Extreme and uncontrollable circumstances. Health Data NY. PQA maintains the PQA-endorsed performance measures and updates the technical specifications for the measures routinely. (A) The maximum value for the modified LIS/DE indicator value per contract would be capped at 100 percent. The stars of hospital care: useful or a distraction? Accessed April 5, 2021. https://data.cms.gov/provider-data/topics/hospitals/overall-hospital-quality-star-rating/, 2. There clearly are hospitals with relatively good performance on multiple quality groups, which thereby earn a 5-star rating. This document is available in the following developer friendly formats: Information and documentation can be found in our (B) Its average CAHPS measure score is statistically significantly higher than the national average CAHPS measure score; (D) Its average CAHPS measure score is more than one standard error above the 80th percentile. (ii) All affected contracts are eligible for the Reward Factor based on the calculations described in paragraph (i)(8)(i) of this section. CMS Releases 2023 Medicare Advantage and Part D Star Ratings to Help It can be used by purchasers or health plans that are designing limited provider networks and whose interest in hospital quality spans the entire range of clinical specialties and programs. Health Aff (Millwood). 2021 CMS Star Ratings for Medicare Advantage Plans - Inovalon 2020;180(6):904-905. doi:10.1001/jamainternmed.2020.0450, What Were Reading: CDC Malaria Warning; NC Abortion Restrictions; Ascension Nurse Strike. Patients often relapse after discharge from acute care because of long waits for outpatient treatment, lack of specialized therapists, out-of-pocket costs, and inadequate social support. (C) A MAPD contract may be adjusted up to three times with the CAI: One for the overall Star Rating and one for each of the summary ratings (Part C and Part D). PDF Overall Hospital Quality Star Ratings: July 2023 Refresh April 24, 2023 Lastly, hospital sample sizes in some parts of the analyses were small, especially in the state-level analysis, limiting our ability to detect significant relationships that we might have otherwise found. (j) Special rules for 2021 Star Ratings only. They are not used in the calculation of the summary or overall ratings. Included in NCQA HPR and Medicare Part C and D Star Ratings NCQA HPR Composites Medicare Star Rating Domains Patient Experience Member Experience with Health Plan (HD3) Member Complaints and Changes in the Health Plan's Performance (HD4) (C) The measure is applicable only to SNPs. Third, our study did not explore the possible impact of the minimum thresholds for a hospital to receive a Star Rating (at least 3 quality groups, one of which must be the outcome groupMortality, Safety of Care, or Readmissionand at least 3 measures in each group).18 Our overall score distribution analysis excluded hospitals with missing scores in any of the 7 quality groups. (1) Medicare Plan Finder performance icons. The Second Plan Preview in September will include actual Star Ratings of each measure and will give plans the opportunity to address concerns over rating calculations to CMS prior to final public reporting of Star Ratings in early October. (5) Exclusion from improvement measures. Differences between the 3 resulting groups were tested using the Kruskal-Wallis test. (1) CMS runs the calculations twice for the highest level rating for each contract-type (overall rating for MAPD contracts and Part D summary rating for PDPs), with the reward factor adjustment if applicable and the CAI adjustment, once including the improvement measure(s) and once without including the improvement measure(s). CMS will determine cut points for the assignment of a Star Rating for each numeric measure score by applying either a clustering or a relative distribution and significance testing methodology. On average, for a given quality measure included in the Star Rating program, 12% of 1-star hospitals received top-quartile scores and 16% of 5-star hospitals received bottom-quartile scores. Accessed April 5, 2021. https://catalyst.nejm.org/doi/full/10.1056/CAT.19.0629, 21. Many hospitals at the top of the summary score distribution had low scores in some measure groups, and many hospitals at the bottom of the score distribution had high scores in some measure groups. No hospitals were either best in all quality groups or worst in all quality groups. This content is from the eCFR and may include recent changes applied to the CFR. The anticipated update is the second since the agency overhauled the ratings' methodology in 2020. (ix) The HEI reward is calculated separately for, and then added to, the overall rating, Part C rating for MAPDs and MA-only contracts (and cost contracts), Part D rating for MAPDs (and cost contracts), and Part D rating for PDPs after the addition of the CAI as specified in paragraph (f)(2) of this section and application of the improvement measures as specified in paragraph (g) of this section and before the final overall and Part C and D summary ratings are calculated by rounding to the nearest half star. Contracts affected by extreme and uncontrollable circumstances do not have the option of reverting to the prior year's improvement rating. (C) The measure is scheduled to be retired or revised. As a (A) The adjustment factor is monotonic (that is, as the proportion of LIS/DE and disabled increases in a contract, the adjustment factor increases in at least one of the dimensions) and varies by a contract's categorization into a final adjustment category that is determined by a contract's proportion of LIS/DE and disabled beneficiaries. The collapsing of the initial categories to form the final adjustment categories would be done to enforce monotonicity in at least one dimension (LIS/DE or disabled). (ii) The measure-level change score calculation described at 423.184(f)(4)(i) is not applied for CAHPS measures and the measure-level change score used for the 2020 Star Ratings is applied in its place for all CAHPS-based measures.
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