The hospital star ratings from CMS may not be fair to hospitals with sicker patients and create “unneeded complexity,” according to the Medicare Payment Advisory Commission (MedPAC), which hinted at creating its own quality measures and payment structure.

The commission, which acts as an advisor to federal lawmakers on Medicare spending, provided feedback on the star ratings in a Sept. 22 letter from its chairman, Francis Crosson, MD, to CMS Acting Administrator Andy Slavitt. Much like the reaction from hospital administrators, the feedback was largely negative, especially concerning how one-star hospitals were assessed compared to the highest-ranking facilities.

In the commission’s analysis, 98 percent of the 128 hospitals given a one-star rating were judged based on all four of the outcome groups (mortality, readmissions, safety and patient experience). For the 102 five-star hospitals, however, only 57 percent were judged on all four of those same groups.   

“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 the hospitals, and therefore may not produce a true 'apples-to-apples' comparison of hospitals,” Crosson wrote.

He noted for one-star hospitals, an average of 78 percent of admissions came through the emergency department (ED), while in five-star hospitals, only 36 percent came through the ED, suggesting hospitals are being penalized for treating more severe cases.

Crosson also expressed a concern for the extra burden the star ratings program puts on hospitals dealing with multiple quality payment and reporting programs. The fact it uses metrics hospitals are already reporting to CMS is little consolation, he argued.

“It represents a new organization of the measure and scoring methodology for CMS to administer and hospitals to track," Crosson wrote. "The commission encourages CMS to align the star rating methodology as much as possible with existing CMS programs, for example the Hospital Value-Based Purchasing (VBP) program."

Crosson recommended CMS continue refining the ratings methodology and said MedPAC may come up with its own version, writing it “plans to discuss methods to compare hospitals on Medicare quality of care and cost, and adjust payment based on that performance.”

CMS said it is working on a response to the commission’s letter.