Hospital five-star ratings to include rural hospitals

When the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, released its initial five-star ratings of more than 3,500 of the nation's hospitals in April, the American Hospital Association noticed something was missing — data from most of the critical access hospitals, the country's smallest hospitals.

But that is likely to change when the next round of Hospital Compare ratings come out in July, the group — which represents 5,000 hospitals and health systems, including 1,600 small, rural hospitals — announced earlier this week.

The ratings are based on patient-experience surveys, which measured patient satisfaction in 11 areas such as how well doctors or nurses communicated with patients, responsiveness of hospital staff and cleanliness of the hospital.

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Hospitals were given an overall summary score as well as scores — from one star up to five stars — for each of the categories for which patients were surveyed. The starred ratings will be updated each quarter, CMS said.

The state's 62 hospitals that received scores in April averaged a 3.8-star rating, with the majority receiving a score of 3 or 4 stars. Only two hospitals scored a 2-star rating — Broadlawns Medical Center in Des Moines and Ottumwa Regional Health Center.

The addition of critical access hospital survey data is in response to a letter sent from the hospital association to CMS that expressed 'deep disappointment' in the April update, which did not include most of the data from the majority of the rural 25-bed hospitals. Iowa has 82 critical access hospitals.

Critical access hospitals are not required to participate in the hospital quality reporting programs, as they typically do not have the necessary patients volumes required for the measurements. But the hospital association noted that 94 percent of the 1,330 critical access hospitals across the country — or 1,252 — are registered to submit quality data to CMS.

Some of the smaller hospitals were give five-star ratings during the initial round of ratings. In fact the one dozen Iowa hospitals that scored a 5 are all located in cities with populations of fewer than 12,000 people.

'The fact that so many CAHs are engaged in voluntary quality reporting demonstrates their commitment to sharing information with the communities they serve, and to identifying opportunities to improve care,' wrote Nancy Foster, AHA vice president of quality and patient safety policy. 'Moreover, many payers — including some Medicaid programs and private insurers — use Hospital Compare data reported by CAHs in their pay-for-performance programs. For these reasons, it is critical that CMS post voluntarily reported data in a timely fashion.'