AHA to CMS: Suspend hospital star ratings, eCQM reporting

In a letter to CMS, the American Hospital Association (AHA) recommended the agency’s deregulation efforts begin with suspending the hospital star ratings, which it called “inaccurate and misleading.”

The AHA has criticized the star ratings since they were first added to the CMS Hospital Compare website in July 2016. Other groups, including the Medicare Payment Advisory Commission (MedPAC), bashed the ratings for not accounting for differences in the patient population served by a facility. After President Donald Trump’s election, the AHA included eliminating the ratings in its list of policy priorities, and it echoed that stance to CMS Administrator Seema Verma.

“While we continue to be concerned that CMS’s methodology is flawed, our concern is amplified by the fact that further analysis performed since the star ratings were first released show that substantive errors were made in executing CMS’s chosen methodology. As a result, far too many hospitals have been incorrectly classified into star rating categories that are different than those that should have been assigned,” the AHA wrote.

CMS hasn’t announced any plans to suspend the ratings. Hospitals were given a preview of their 2017 ratings in April and May, with the data expected to be posted publicly on the Hospital Compare site in July.

Beyond the star ratings, the AHA made numerous recommendations for CMS regulations to be rolled back or eliminated, including:

  • Cancel Stage 3 of meaningful use: The association said the existing regulations are burdensome, unnecessary and will force hospitals to make significant investments in electronic health record upgrades to meet the requirements. It asked CMS to remove the 2018 start date for the regulation and switch every future year of the program to a 90-day reporting period.
  • Suspend electronic clinical quality measure (eCQM) reporting requirements. The AHA said there’s been no benefit to patient care from revising certified EHRs, and said CMS itself had acknowledged the eCQM reports “do not accurately measure the quality of care provided.” It also encouraged CMS to reduce the number of quality measures hospitals need to report and remove “faulty” measures recently added to inpatient and outpatient quality reporting.
  • Withdraw rule on Medicaid disproportionate share hospital (DSH) payments. The April rule clarified when calculating uncompensated care costs, CMS would take into account what hospital received from other sources, like commercial insurance or the patients themselves. The AHA said this constituted a substantial change in policy which could “significantly limit or eliminate some hospitals’ access to Medicaid DSH funds.”
  • Make future bundled payment programs voluntary. The AHA has repeatedly argued CMS doesn’t have the authority to make these new payment models mandatory. The agency has already delayed the start of two mandatory bundles to 2018.
  • Create safe harbors in the Anti-Kickback Statute for clinical integration and patient assistance: The AHA said current laws “impede innovation” in these areas because they’re based on the fee-for-service payment structure. New safe harbors would allow “collaborative models that reward values and outcomes.”