Fact Sheets
Hospital Compare Star Ratings Fact Sheet
Hospital Compare Star Ratings Fact Sheet
Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide care to their patients. This information can help consumers make informed decisions about health care. Hospital Compare allows consumers to select multiple hospitals and directly compare performance measure information related to heart attack, heart failure, pneumonia, surgery and other conditions.
The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey is a standardized survey instrument and data collection methodology to measure patients’ perspectives of their hospital care. The HCAHPS measures were created to publicly report patients’ perspectives on their hospital care. HCAHPS results posted on Hospital Compare provide ratings, including comparisons to state and national averages, that help consumers understand how hospitals perform. Posting these results support the Obama Administration’s efforts to build a health care system that delivers better care, spends health care dollars more wisely, and results in healthier people.
On April 16, 2015, the Centers for Medicare & Medicaid Services (CMS) added HCAHPS Star Ratings to the Hospital Compare website as part of the initiative to add 5-star quality ratings to its Compare websites. CMS and the Agency for Healthcare Research and Quality have led a partnership of public and private organizations to publicly report patients’ perspectives of hospital care. CMS believes that star ratings spotlight excellence in health care quality and make it easier for consumers to use the information on the Compare websites. This is consistent with the call for transparent, easily understood and widely available public reporting found in the Affordable Care Act. The ratings also support using quality measures as a key driver of health care system improvement.
Twelve HCAHPS Star Ratings appear on Hospital Compare: one for each of the 11 publicly reported HCAHPS measures, plus the new HCAHPS Summary Star Rating. HCAHPS Star Ratings are the first star ratings to appear on Hospital Compare and CMS plans to update the HCAHPS Star Ratings each quarter.
Background
CMS created the HCAHPS Star Ratings to enable consumers to more quickly and easily assess the patient experience of care information that is provided on the Hospital Compare website. Star ratings will also allow consumers to more easily compare hospitals. CMS already uses star ratings in other Compare websites, as well as in Medicare Plan Finder. Currently, Nursing Home Compare features an overall star rating for each facility and star ratings for other important categories of health care quality. In 2014, CMS introduced star ratings to Physician Compare, which uses them to rate a limited number of measures for group practices. In January 2015, CMS added star ratings to Dialysis Facility Compare and plans to add them to Home Health Compare later this year. Medicare Plan Finder uses star ratings to help beneficiaries select parts C and D plans. These star ratings also determine quality bonus payments for plans.
Purpose of HCAHPS Star Ratings
HCAHPS Star Ratings provide a quick summary of each HCAHPS measure in a format that is increasingly familiar to consumers and enable consumers to more quickly and easily assess the patient experience of care information.
CMS encourages consumers to consider multiple factors when choosing a hospital. Other data that are publicly reported on Hospital Compare can be very useful. The new HCAHPS Star Ratings summarize one aspect of hospital quality—patients’ experience of care. In addition, consumers should discuss hospital quality with their healthcare professionals when selecting a hospital.
HCAHPS Summary Star Rating
The HCAHPS Summary Star Rating combines or rolls up all of the HCAHPS Star Ratings.
The HCAHPS Summary Star Rating combines all information about the specific aspects of patient experience of care measured by the HCAHPS Survey. The existing Overall Hospital Rating measure (and its star rating) is derived from a single survey item. CMS believes that each measure is valid and is useful to consumers, and consumers have indicated these pieces of information are important in their decision making. Patients and consumers can drill down from the HCAHPS Summary Star Ratings to examine each of the star ratings they summarize.
Frequency and Source of Data
CMS will update HCAHPS Star Ratings on a quarterly basis. HCAHPS Star Ratings are based on the same data that are used to create the HCAHPS measures publicly reported on the Hospital Compare website. The first public reporting of the HCAHPS Star Ratings in April 2015 is based on patients discharged between July 1, 2013 and June 30, 2014. HCAHPS Star Ratings, including the star ratings level thresholds, will be recalculated for each public reporting.
The HCAHPS Survey of hospital inpatients is the source of information for the HCAHPS Star Ratings and the HCAHPS measures publicly reported on Hospital Compare. For more information, see the HCAHPS Fact Sheet available at http://www.hcahpsonline.org/Facts.aspx
Types of Hospitals Included in HCAHPS Star Ratings
All hospitals that participate in the HCAHPS Survey are eligible to receive HCAHPS Star Ratings, which includes both Inpatient Prospective Payment System (IPPS) hospitals and Critical Access Hospitals (CAH). IPPS hospitals are required to report HCAHPS as part of the Hospital Inpatient Quality Reporting (IQR) Program and CAHs voluntarily participate.
In addition, hospitals must have at least 100 completed surveys in the 12-month reporting period and be eligible for public reporting in order to receive HCAHPS Star Ratings.
HCAHPS scores based on fewer than 100 completed surveys do not have the required statistical reliability for HCAHPS performance measurement.
Summary of HCAHPS Measures Used to Determine HCAHPS Star Ratings
There is a star rating for each of the following HCAHPS measures (drawn from questions on the HCAHPS Survey, as indicated):
- HCAHPS Composites Measures
- Communication with Nurses (Q1, Q2, Q3)
- Communication with Doctors (Q5, Q6, Q7)
- Responsiveness of Hospital Staff (Q4, Q11)
- Pain Management (Q13, Q14)
- Communication about Medicines (Q16, Q17)
- Discharge Information (Q19, Q20)
- Care Transition (Q23, Q24, Q25)
- HCAHPS Individual Items
- Cleanliness of Hospital Environment (Q8)
- Quietness of Hospital Environment (Q9)
- HCAHPS Global Items
- Overall Hospital Rating (Q21)
- Recommend the Hospital (Q22)
Methodology of HCAHPS Star Ratings
HCAHPS survey responses are first converted to linear mean scores for each HCAHPS measure and then adjusted for patient mix and mode of survey administration. Next, a statistical clustering algorithm groups hospitals into five star categories for each HCAHPS measure. For more details, please see the Technical Notes for HCAHPS Star Ratings.
HCAHPS Star Ratings are assigned in a way that minimizes differences within groups and maximizes differences between groups. The clustering algorithm empirically determines the number of hospitals in each star rating category independently for each HCAHPS measure.
Linear-mean scores and top-box scores are alternative, statistically valid methods for summarizing HCAHPS performance. Linear-mean scores incorporate the full range of survey response categories into a single metric for each HCAHPS measure. On the other hand, top-box scores consist of only the most positive response to HCAHPS survey items. Please note that Hospital Compare reports top-box, middle-box and bottom-box scores for all HCAHPS measures. See: http://www.medicare.gov/hospitalcompare/search.html.
HCAHPS Star Ratings and the Overall Hospital Star Rating
In addition to adding HCAHPS Star Ratings to Hospital Compare in April 2015, CMS is developing a methodology for an overall hospital star rating that includes the full range of quality measures reported on Hospital Compare. We believe that an overall hospital rating will be helpful to consumers by allowing them to more easily compare the quality provided by hospitals. The overall hospital star rating will conveniently provide additional information to consumers.
CMS has contracted with Yale University to develop this methodology. Yale University has convened a national technical expert panel (TEP) of consumers, hospital representatives, public reporting experts, and methodology experts to provide feedback and guidance in developing this methodology. The materials and discussions from the TEP meetings have been and will continue to be made public for public review and comment. For more information, please see:
CMS intends to implement an overall hospital star rating in 2016.
Additional Resources
For additional information about the HCAHPS survey, please visit the Survey of Patients’ Experiences page on Medicare.gov, the HCAHPS On-Line Web site, www.HCAHPSonline.org, or the HCAHPS Fact Sheet.