I was just getting up to speed on the new HHC Star Ratings (recently renamed Quality of Patient Care Star Ratings), when CMS announced an additional set of Star Ratings for HHCAHPS. CMS introduced these new ratings at the May 7 th, 2015 Special Open Door Forum (SODF) to be publically reported starting in January 2016, for patients receiving care July 2014 – June 2015. So, there is not much time to improve your scores before the first cut off.
I guess we should not be surprised. CMS has been on a path to report Star Ratings across the health care industry to make it easier for consumers to spotlight excellence in healthcare quality. Along with Star Ratings on Nursing Home Compare, Medicare Advantage Plan Finder and Physician Compare, CMS also recently introduced Hospital CAHPS Star Ratings.
Unlike with the introduction of the Quality of Patient Care Star Ratings, CMS did not seem interested to solicit provider input to consider changes in how the ratings would be calculated. With their experience in survey based Star Rating from other market segments, they probably feel they have it right already.
Patient Survey Star Rating Overview
There are four measures that will be publically reported for the Star Ratings along with a Survey Summary Rating:
- 1. Care of Patients Composite (Q9, Q16, Q19, Q24)
- 2. Communications Between Providers and Patients Composite (Q2, Q15, Q17, Q18, Q22, Q23)
- 3. Specific Care Issues Composite (Q3, Q4, Q5, Q10, Q12, Q13, Q14)
- 4. Overall Rating of Care (Q20)
The average of these four scores will be shown as the Survey Summary Star Rating. Unlike the Quality of Patient Care Ratings, there will be no half star ratings. The methodology they will use is also quite different. The responses to the survey questions will be converted into a 0 -100 “linearized” score, converting answers like “never” to equal 0, “sometimes” to 33 1/3, “usually” to 66 1/3 and so forth. The scores will then be summarized and adjusted for patient mix to account for the fact some patient subgroups respond more positively or negatively to the surveys (see https://homehealthcahps.org/).
Once adjusted and rounded, the four measures will be converted into five groupings by applying a statistical clustering algorithm. These clusters are the basis for assigning the cut points for the Star Ratings. CMS shared an example of the cut points for patients receiving care for the year ending June 30, 2014.
| Star Rating | Care of Patients | Communications Between Providers and Patients | Specific Care Issues | Overall Rating of Care |
|---|---|---|---|---|
| 1 Star | < 89 | < 86 | < 77 | < 88 |
| 2 Stars | ≥ 89 to 92 | ≥ 86 to 89 | ≥ 77 to 80 | ≥ 88 to 91 |
| 3 Stars | ≥ 93 to 94 | ≥ 90 to 91 | ≥ 81 to 84 | ≥ 92 to 94 |
| 4 Stars | ≥ 95 to 96 | ≥ 92 to 94 | ≥ 85 to 88 | ≥ 95 to 96 |
| 5 Stars | ≥ 97 | ≥ 95 | ≥ 89 | ≥ 97 |
I recommend agencies look at these cut points to approximate their star ratings. Interestingly, if a provider scores 91 on the three composites and 91 for the overall rating of care, the Survey Summary Star Rating would only be 3 stars. In my school days, a 91 would be an A-.
Looks like we have more work to do before we can go outside.
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