Healthcare News & Insights

CMS releases star ratings, announces big changes: What’s coming for hospitals

The Centers for Medicare & Medicaid Services (CMS) recently updated its overall hospital quality star ratings for the first time since 2017, but the ratings may not exist in their current form for much longer. Here’s why: The agency’s considering revamping the program – and some of the proposed changes are significant. 

Since they were initially implemented, the star ratings were criticized by many stakeholders in the healthcare industry. One of the most common complaints was that the measures used to compare facilities were poorly grouped, so the ratings weren’t completely accurate.

Another big issue: Facilities that typically treated large amounts of critically ill or disadvantaged patients were often unfairly penalized with a lower rating.

CMS considered these complaints, and they were part of the reason the agency hasn’t updated its star ratings for hospitals in almost two years. Now it’s thinking of making big changes to the program, and it’s requesting additional feedback from hospitals, providers and other stakeholders before issuing additional ratings.

Proposed changes to star ratings

The agency just released a request for public comment asking for suggestions on pending changes to the methodology it uses to calculate hospitals’ ratings.

One big proposed change: CMS wants to refine some of the groupings for the measures it uses for the ratings. It wants to regroup them through three steps:

  1. Putting measures together based on clinical criteria
  2. Using statistical tests to make sure important quality traits are accurately represented by the grouped measures, and
  3. Regularly reviewing measure groupings to make sure each measure is consistent in how much it influences the entire group score.

CMS is also considering a change to what it calls “measure precision,” which essentially weights certain measures higher if the quality measures impact more patients. For example, if a hospital treats thousands of heart failure patients, but only 20 pneumonia patients, the heart failure measure would be weighted much higher and have more of an impact on the hospital’s score.

The agency wants feedback on whether measure precision should be included in the star rating as-is, accounted for in another way or deleted from the scores entirely.

In addition, CMS may change the frequency with which it updates the star ratings due to complaints about how the ratings unfairly “shift” if they’re updated more than once in a 12-month period, even if there are no changes to the methodology that generated them.

While the agency said some of this shift is natural based on changes in hospital performance, it’s asking for feedback on whether it’s more helpful to report on measures once a year – or if it should try another strategy, such as combining the data from two recent quality reporting periods instead of analyzing it separately.

Other changes the agency is considering to make the star ratings more accurate include evaluating hospitals together in “peer groupings” of facilities with similar demographics and patients, incorporating a hospital’s efforts to improve in the overall score and using a different type of model to calculate scores.

Feedback and comments on all the proposed changes to the hospital star rating program can be submitted to CMS until March 29 at

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