# CMS Hospital Ratings **URL:** \ **Category:** Great Debates\ **Created:** [July 28, 2016, 9:24pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146 "2016-07-28T21:24:19Z")\ **Posts on this page:** 12\ **Page:** 1
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [July 28, 2016, 9:24pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/1 "2016-07-28T21:24:19Z")
[New quality ratings roil hospitals, give consumers help](http://www.cnbc.com/2016/07/27/new-quality-ratings-roil-hospitals-give-consumers-help.html) > [@](#): > > New overall quality ratings that assign individual hospitals one to five stars based on how well they care for patients were released Wednesday by the federal government, giving consumers a new tool for making health-care choices for themselves and loved ones. > > A number of prestigious hospitals did not score as high on the new ratings as their reputations, and own websites and marketing materials, might otherwise suggest. > [@](#): > > Nearly all of the hospitals that scored at the top of U.S. News & World Report’s oft-touted “Best Hospital” rankings failed to obtain a top five-star overall quality rating from Hospital Compare. > [@](#): > > In an emailed statement, a UPMC spokeswoman said, “UPMC is a 20-plus hospital integrated health system that typically cares for the sickest of the sick across western Pennsylvania. Ten of our 13 hospitals rated by CMS rank at three stars or higher.” > > “That said, UPMC and many leading academic medical centers across the country have raised concerns about the questionable methodology used in this process, which does not appropriately adjust for patient complexity and socio-economic status,” said the spokeswoman, Wendy Zellner. “This has led to low ratings for many prominent hospitals that provide excellent care. We support the public reporting of quality data, but look forward to working with CMS and others to refine these measures and methodologies in the future.” 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. ---
**Author:** ![yellowjacketcoder](https://avatars.discourse-cdn.com/v4/letter/y/4bbf92/32.png) [@yellowjacketcoder](https://boards.straightdope.com/u/yellowjacketcoder)\ **Post date:** [July 29, 2016, 3:15pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/2 "2016-07-29T15:15:43Z")
> [@](#): > > Mort said some of CMS’ star rating measurements “are significantly flawed,” particularly the “readmission rate,” which tracks how many patients are readmitted to a hospital within 30 days of discharge. “It’s probably not a very good measure of hospital quality,” she said. 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. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [July 29, 2016, 3:54pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/3 "2016-07-29T15:54:46Z")
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. The two-star place is gonna be _pissed_. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [July 29, 2016, 4:00pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/4 "2016-07-29T16:00:36Z")
> [@yellowjacketcoder](#): > > 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. 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.] ---
**Author:** ![Bullitt](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bullitt/32/5725_2.png) [@Bullitt](https://boards.straightdope.com/u/Bullitt)\ **Post date:** [July 29, 2016, 4:20pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/5 "2016-07-29T16:20:42Z")
It is a simplistic rating system that is but a starting point. If people want more data, they’re welcome to dig. ---
**Author:** ![yellowjacketcoder](https://avatars.discourse-cdn.com/v4/letter/y/4bbf92/32.png) [@yellowjacketcoder](https://boards.straightdope.com/u/yellowjacketcoder)\ **Post date:** [July 29, 2016, 5:41pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/6 "2016-07-29T17:41:33Z")
> [@Fotheringay-Phipps](#): > > 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. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [July 29, 2016, 6:05pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/7 "2016-07-29T18:05:18Z")
But the point is that most people won’t, and that this will influence how hospitals act. ---
**Author:** ![yellowjacketcoder](https://avatars.discourse-cdn.com/v4/letter/y/4bbf92/32.png) [@yellowjacketcoder](https://boards.straightdope.com/u/yellowjacketcoder)\ **Post date:** [July 29, 2016, 6:18pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/8 "2016-07-29T18:18:57Z")
> [@Fotheringay-Phipps](#): > > But the point is that most people won’t, and that this will influence how hospitals act. It’s like you didn’t read my post at all, and just posted a shorter version of post 4. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [July 29, 2016, 6:28pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/9 "2016-07-29T18:28:59Z")
My prior post was addressed to **bullitt** , not YJC. > [@yellowjacketcoder](#): > > 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. 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. ---
**Author:** ![Bullitt](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bullitt/32/5725_2.png) [@Bullitt](https://boards.straightdope.com/u/Bullitt)\ **Post date:** [July 29, 2016, 6:31pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/10 "2016-07-29T18:31:08Z")
> [@Fotheringay-Phipps](#): > > But the point is that most people won’t, and that this will influence how hospitals act. So? Each person devotes what time they have according to their priorities. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [July 29, 2016, 6:38pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/11 "2016-07-29T18:38:56Z")
Reread the OP, and the second sentence of post #4. ---
**Author:** ![Bullitt](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bullitt/32/5725_2.png) [@Bullitt](https://boards.straightdope.com/u/Bullitt)\ **Post date:** [July 29, 2016, 6:42pm UTC](https://boards.straightdope.com/t/cms-hospital-ratings/761146/12 "2016-07-29T18:42:29Z")
> [@Fotheringay-Phipps](#): > > 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.] I agree here.