CRE: CMS’ Five-Star Quality Rating System is a Violation of Medicare and APA Rulemaking Requirements

CMS’s Five-Star Quality Rating System for Part C and D Medicare is laudible concept for using informed consumer choice rather than command-and-control regulation to improve the healthcare market. However, because the Star Rating System is now used to determine bonuses, rebates, and eligibility, CMS is statutorily required to implement the ratings through Federal Register notice-and-comment rulemaking proceedings.

In the letter to CMS attached here, the Center for Regulatory Effectiveness explains the deficiencies in how the ratings were developed. CRE concludes that CMS should

1. Follow Federal Register notice-and-comment rulemaking proceedings for the star ratings programs.

Medicare Rankings Favor Small, For-Profit Hospitals

From: The Hospitalist

Kelly April Tyrrell

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The decision has not been met without controversy, particularly given the fact that just 251 hospitals out of more than 3,500 received five stars, and only two major teaching hospitals achieved the highest rating. Some professional groups, like the American Hospital Association (AHA), which issued a statement the day CMS released its ratings, believe the rankings risk “oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons.”

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Medicare’s Hospital Compare adds star rating but fails to score with critics

From: Senior Journal

Editor’s note: New star rating system gets some hoarse criticism at Kaiser Health News

April 16, 2015 – Medicare’s Hospital Compare website may have added the star rating system today but the new service – well, even the earlier service – is not getting five stars from Jordan Rau of Kaiser Health News. His article published today is below. It is a “must read” for senior citizens planning on using the service to choose a hospital.

Only 251 Hospitals Score Five Stars in Medicare’s New Rating

By Jordan Rau, Kaiser Health News

What Do CMS Five Star Ratings Really Mean?

In their report, Chemical Restraints: Anti-psychotic meds given to elderly despite warnings, ABC News 10 in Sacramento, CA reports that,

As documented in a coroner’s investigative report, Conover also said she thinks the drugs contributed to her mom’s death just 12 days after she was admitted to Roseville Point Health and Wellness Center.

She was as assessed when she entered Roseville Point as a well developed, well nourished 82-year-old female complaining of back pain to being triaged to Kaiser 10 days later as ill-appearing, obtunded, which is a medical term for being in a vegetative state.

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CRE Informs the Media that CMS Star Ratings Could Violate the Data Quality Act

Editor’s Note: CRE has informed Inside CMS, a premier media organization, of potential deficiencies in the CMS Star Rating program.

Editor: Inside CMS

The following email was sent to a number of individuals associated with the CMS Star Rating System as applied to hospitals.

Respectfully,

Jim Tozzi

Center for Regulatory Effectiveness

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Dear___:

I am with the CRE, the Center for Regulatory Effectiveness, a regulatory watchdog which intervenes in regulatory proceedings when it appears that government regulations are not science based.

We work to ensure compliance with the Data Quality Act; see the following article from the New York Times http://www.thecre.com/quality/20020321_nytimes.htm