IMO, a poor, overly simplistic, rating system is worse than no rating system at all.
And the important point is that the problem is not just that an individual might be misled by these ratings. The problem is that to the extent that these ratings “punish” hospitals for things like treating complex cases or treating low income populations, hospitals would be incented to shy away from doing these things for fear it would hurt their ratings. When an institution like CMS does things, people take notice, and a hospital can be hurt by having CMS brand them as inferior.
Which is even besides for the prospect that having a rating system get entrenched at CMS harbors the prospect that at some point it will be used for financial rewards and punishments, which would only magnify the issue.
I dunno, if a hospital gives good treatment to it’s wealthy patients but the poor patients aren’t getting good treatment, that could be a cause for concern even if the hospital is good overall. Now, it’s fair to say that poor patients are less likely to practice the follow up treatments or be able to afford the medication, but I don’t think it’s a problem to point out where hospitals have flaws.
Sometimes it’s good to re-examine how good we think our institutions are.
Huh, the main hospital I work at hasn’t been rated (yet?). But our sister hospital a dozen miles away got three stars, and the chief competing hospitals got two and three stars respectively.
But if readmission rates are treated as a “flaw” even when they’re influenced by patient behavior which is not being captured (or by severity of pre-existing health condition) then that’s a problem.
If, as you suggest, “poor patients are less likely to practice the follow up treatments or be able to afford the medication”, then that’s a big disincentive for a hospital to market themselves to poor patients. Because they will get dinged for high readmission rates that are due to factors not completely under their control.
[Not that hospitals are so eager to get poor patients to begin with - they need to get paid, for one thing. But this makes it worse.]
Alternatively, it may mean they need to reform the way they give care. Giving the same after-care instructions to an upper-class lawyer and a lower-class retail worker doesn’t seem like a good idea. We tailor medical treatment to the diagnosis, but we should also tailor instructions to the patient.
This is similar to the common complaint I’ve heard of “Well, Dr. Smith prescribed this medicine, but it’s $50 a pill! Is he nuts!?” and medical professionals sometimes admitting they have no idea how much a particular regimen of treatment would have as an end cost. That might be good treatment but it’s poor care.
I realize this is more work for already overworked doctors and hospitals, but when people’s lives and well being are at stake, I think it’s appropriate to take the extra time and effort to ensure that the care being given is appropriate to the patient’s ability to follow that care. This doesn’t mean that I think the CMS rankings are golden (it would be hypocritical of me to suggest that the hospital get more complex while the ranking system can stay relatively simple), but with a 64 point measurement for the star rankings that system seems fairly complex already.
Ultimately though, hospitals are businesses. They don’t really care what their ranking is except for how it changes the number of paying patients that attend. If a hospital has a 1 star ranking but is raking in the cash by serving all the patients the other hospitals rejected, the hospital admin is going to be pretty pleased.
But that assumes that there is a way to produce the same outcomes in upper-class lawyers as in lower-class retail workers. I’m skeptical as to whether this is the case, and you need a basis for that assumption.