Nursing & Healthcare News

Controversial Hospital Star Rating System Continues

CMS metrics called inaccurate and misleadin

Blue "Hospital" sign on a white building with another blue building behind it

Despite the urging of hospital associations, the Centers for Medicare & Medicaid Services (CMS) are going forward with their controversial Hospital Compare ratings for 2020, delaying any major changes to the methodology for another year.


Launched back in 2005 and published on, Hospital Compare assigns hospitals a single overall star rating, from one to five stars, based on quality reporting measures. Hospitals and hospital associations have long criticized the way CMS uses those metrics to calculate the ratings, which the American Hospital Association (AHA) has called “inaccurate” and “misleading.”

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Despite those complaints, CMS plans to retain the current system for the 2020 ratings. Administrator Seema Verma, MPH, promises that the agency will reevaluate its methodology based on stakeholder feedback, but any changes won’t take effect before 2021.

“Longstanding Concerns”

AHA Sr. Vice President for Public Policy Analysis and Development Ashley Thompson says her organization “is disappointed that CMS intends to continue using a hospital star ratings approach plagued by longstanding concerns about its accuracy and meaningfulness.” She thinks CMS should hold off on releasing new ratings until the methodology gets a complete overhaul.

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America’s Essential Hospitals President and CEO Bruce Siegel, M.D., MPH, has called on CMS “to suspend publication of the ratings … to avoid confusion among patients and disproportionate effects on hospitals.”

Comparing Apples to Oranges

In March, Siegel wrote a nine-page letter to CMS, detailing a litany of complaints about the rating methodology (such as the lack of risk adjustment for patients’ socioeconomic status, which penalizes hospitals that treat poorer, sicker patients) and questioning the value of assigning star ratings at all.

“A hospital’s single, simplified rating might fail to capture its particular expertise in an area of care most important to a given patient,” he warned. “For example, a hospital’s complication rate after an orthopedic procedure provides little useful information to a woman deciding where to give birth.”

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