Patient Satisfaction News

How CMS Hospital Star Ratings Impact Patient Satisfaction

In promoting hospital quality data transparency, the CMS hospital star ratings help boost patient satisfaction and deliver informed patient decision-making.

By Sara Heath

- In an effort to increase patient satisfaction transparency and boost consumer empowerment in making treatment decisions, the Centers for Medicare & Medicaid Services created the hospital star ratings system as a part of their Hospital Compare website.


Implemented in 2014, the star ratings system sought to provide patients with a clear, easy-to-understand means of reviewing patient satisfaction and hospital quality. In providing patients with a five-star scale, CMS was determined to synthesize all patient satisfaction and other hospital data to help patients make informed decisions.

However, the star ratings program has not come without its controversies. Most recently, members of Congress introduced a bill calling to delay the implementation of an updated star ratings program, stating that the calculations for those ratings were flawed.

This bill came with support from several healthcare professional organizations, including the American Hospital Association. AHA also previously spearheaded a letter to the federal agency's Deputy Administrator for Innovation and Quality Patrick Conway, MD. The letter voicing concerns with the star rating system was also signed by the Association of American Medical Colleges, America’s Essential Hospitals, and the Federation of Hospitals.

But what is the CMS star rating program, and what are the patient-centric intentions behind it? Below, takes a look at hospital star ratings and the role patient satisfaction plays in them.

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What is the star rating program?

The hospital star ratings are a part of the CMS Hospital Compare website, which provides patients with hospital quality data. The federal agency intended this website to serve as a patient empowerment tool by providing consumers with the information they need to make informed care decisions.

In 2014, CMS added a five-star rating system to Hospital Compare, synthesizing 64 patient satisfaction and experience data points into easy-to-understand stars.

According to CMS, Hospital Compare uses a method to combine several measures into one:

The Star Rating, which was developed through a public and transparent process, takes 64 existing quality measures already reported on the Hospital Compare website and summarizes them into a unified rating of one to five stars. The rating includes quality measures for the routine care an individual receives when being treated for heart attacks and pneumonia to quality measures that focus on hospital-acquired infections, such as catheter-associated urinary tract infections.

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The patient-centric impacts of this star rating system are twofold.

First, these ratings theoretically empower patients to make their own decisions about their healthcare. Through quality transparency, patients can make better decisions about which hospitals to visit.

Second, the star ratings take into account Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, which directly incorporates patient satisfaction data into the star ratings and makes them a reflection of patient testimony.

Providing patients with data on hospital quality

CMS officials report that their primary goal in developing the star ratings was to make hospital quality data transparency palatable for patients. Because patients, who are often also seen as healthcare consumers, may be used to seeing star ratings on retail websites, CMS viewed star ratings as a logical method to help communicate with patients.

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Said Conway in a 2014 blog post announcing the program:

It can be overwhelming when consumers are faced with having to choose a health care provider, such as a hospital, nursing home, or physician. Providers differ in the safety and quality of care they give, and having quality ratings available to compare providers can help consumers make more informed health care decisions. That’s why the Centers for Medicare & Medicaid Services (CMS) is committed to making it easier to use the information on our Compare sites.

By making hospital quality data — as well as patient satisfaction and experience data — transparent to healthcare consumers, CMS can use its star ratings program to boost patient satisfaction.

Furthermore, the star ratings help make that process easier for patients. Instead of asking patients to glean insights from multiple data points, CMS is providing an easy-to-understand method by which patients can make quick and informed care decisions.

Using HCAHPS on Hospital Compare

An important aspect of collecting hospital quality data intended for patient analysis is incorporating information about patient satisfaction. In 2008 CMS added CHAHPS scores as a part of the Hospital Compare websites, and they have also included HCAHPS scores as a part of the star ratings calculation.

“CMS has created the HCAHPS Star Ratings in order to enable consumers to more quickly and easily assess the patient experience of care information that is provided on the Hospital Compare Web site,” the HCAHPS website states. “Star ratings, which CMS plans to roll-out on other Compare Web sites as well, will also allow consumers to more easily compare hospitals.”

Incorporating HCAHPS scores adds to the patient-centered effort CMS has put forth in developing their star ratings by making data about patient satisfaction better available to patients. This fuels patient empowerment and decision-making.

Hospitals agree with data transparency

As noted above, the star ratings program has received criticism from the healthcare industry. A newly introduced bill calls for a delay in a star ratings update, asking CMS instead to better develop the ratings calculations to reflect a more accurate assessment of hospital quality (and ideally helping patients make even more informed decisions).

Industry groups like AHA also want CMS to improve its star ratings, but they agree with the overall sentiment of helping patients make decisions.

In a letter to Conway earlier this month, AHA, AAMC, America’s Essential Hospitals, and FAH all called on CMS to inform the public the calculations for the star ratings and clarify their accuracy.

They also explained their commitment to aiding patient decision-making.

“Hospitals are investing significant resources to collect, report and use data on hundreds of quality measures — for CMS and other payers and regulators — to inform the public about quality and identify opportunities for performance improvement,” the organizations wrote.

As more conversations regarding the star ratings continue, healthcare experts must identify the best method by which they can engage patients in their care decisions, educating them about hospital and facility quality.

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