CMS Hospital Compare: Is Your Facility Making the Grade?

CMS Hospital Compare: Is Your Facility Making the Grade?

Make quality of care a driving force as you improve and maintain your facility’s star rating.

Hospital Compare is a component of the Centers for Medicare & Medicaid Services (CMS) Hospital Quality Initiative. There are up to 57 quality measures in which hospitals can participate, and scores are published on the CMS website. These scores translate into a “star rating” for each facility. This information allows healthcare consumers to have up-to-date, transparent information to help aid in selecting a hospital fit to service their needs.

Consumers can compare hospitals using a five-star scale: more stars indicate better quality care. Up to three hospitals can be compared, at a time. You can perform a general search or search by medical condition or surgical procedures. Categories found on Hospital Compare include ratings based on mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging. The national average comparison highlights if your facility is performing at, below, or above the national average.

Take Control of Your Information

As a hospital administrator or practice manager for a provider-based facility, familiarize yourself with this website and the publicized information (www.medicare.gov/hospitalcompare/search.html). You can view the same data as your current and prospective patient, including your facility’s recommended treatment on common conditions such as heart failure, asthma, and pneumonia. Also found on the website is information related to readmissions and 30-day mortality rates for certain conditions.

Prior to the release of data, CMS allows hospitals a 30-day review period. The reports are housed on the QualityNet secure portal, which is a CMS-approved healthcare quality data exchange. Identified errors, or corrections you believe are necessary, should be submitted during the review period.

Improve Your Rating

What should you do if your facility receives a low star rating?

  • Pay attention to your reporting. You have the data in hand before reporting it to CMS, so you can target risk areas and make an improvement plan.
  • Look for measures you should participate in or measurable activities you already perform, but don’t report.
  • Assess the measures you are participating in but failing.
  • Identify steps for clinical staff to take (e.g. increased patient education from physician or ancillary staff), customer care staff (e.g., patient call backs post treatment), or information technology staff (e.g., improved electronic health record functionality) to improve your facility scores.

Involve key stakeholders in this process; for example, consider implementing a quality committee. Bring leaders from different sectors of your organization together to improve processes. It’s not uncommon to have overlay or duplicate work across departments. For example, data from revenue cycle, health information, finance, pharmacy management, and compliance can be “mined” and shared across an organization. Working in silos benefits no one. Set benchmarks in your provider-based group or facility that align with the measures offered by CMS.

Some measures will be more easily fixed than others. For example, consider the Hospital Compare category Efficient Use of Medical Imaging. Measurable activities for this category include “Outpatients who got cardiac imaging stress tests before low-risk outpatient surgery” and “Outpatients with low-back pain that had an MRI without trying recommended treatments first, such as physical therapy.” These activities can be improved with staff education, efficient work-flow processes, and patient education.

On the other hand, the Patient Experience category with measurable activities such as “Patients who reported that their nurses communicated well” and “Patients who reported that the area around their room was quiet at night” may be more challenging to counter because patient perspectives can differ, widely.

Your compliance, clinical documentation improvement (CDI), and coding departments should engage certain measures: for instance, the Measures of Complications, Deaths, and Unplanned Hospital Visits. This measure uses claims data to calculate hospital-specific death rates without any chart review. It allows for risk adjustment, taking into consideration a patient’s age, past medical history, and comorbidities present on admission. Hospitals who earn top-star rating usually perform well with this measure.

For information on the Hospital Compare start ratings, read the blog “CMS Updates Hospital Compare Star Ratings” in the AAPC Knowledge Center at: www.aapc.com/blog/35839-cms-updates-hospital-compare-star-ratings/

Make HCCs Part of Your CDI Efforts

Hospitals should review ICD-10-CM linked hierarchal condition categories (HCC) codes in their CDI efforts. As CDI specialists examine the record for higher specificity in diagnosis code assignment, missed comorbid conditions and major comorbid conditions opportunities, and diagnosis-related group validation, they also can identify the HCC codes that may influence a patient’s severity of illness and/or risk of mortality scores. These ultimately affect a facility’s bottom line.

Hospital Compare is more than likely here to stay. There is an abundance of information available to consumers when choosing their healthcare providers. Quality of care should drive all your initiatives as you plan, prepare, improve, or maintain your facility’s star rating. Although the star rating is not a pay-for-performance program, many of the measures used to determine these ratings are also used in the Hospital Value-based Purchasing Program, the Hospital-acquired Conditions Reduction Program, and the Hospital Readmissions Reductions Program, which have a financial impact on your facility.

Resources

Hospital Compare: www.medicare.gov/hospitalcompare

Hospital Quality Initiative: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/index.html

CMS, Guide to Choosing a Hospital: www.medicare.gov/Pubs/pdf/10181-Guide-Choosing-Hospital.pdf

Lee Williams

Lee Williams

Lee Williams, RHIT, CPCO, CPC, CEMC, CCS, CCDS, has more than 14 years of experience as a coding director, auditor, educator, trainer, and practice manager. She holds a degree in Health Information Technology and is director of Medical Coding at Ga Cancer Specialists/Northside Hospital Cancer Institute. Williams also provides consulting services for Karna, LLC, on research coding projects sponsored by the Centers for Disease Control and Prevention and U.S. Consumer Product and Safety Commission. Her specialties include medical coding, E/M auditing, ED coding/auditing, DRG assignment, CDI, CMS guidelines, OIG restructuring, MAC/RAC/ZPIC audits, HIPAA, physician/coder training, and pay for performance measures. She serves on AAPC’s National Advisory Board, representing Region 4.
Lee Williams

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Lee Williams, RHIT, CPCO, CPC, CEMC, CCS, CCDS, has more than 14 years of experience as a coding director, auditor, educator, trainer, and practice manager. She holds a degree in Health Information Technology and is director of Medical Coding at Ga Cancer Specialists/Northside Hospital Cancer Institute. Williams also provides consulting services for Karna, LLC, on research coding projects sponsored by the Centers for Disease Control and Prevention and U.S. Consumer Product and Safety Commission. Her specialties include medical coding, E/M auditing, ED coding/auditing, DRG assignment, CDI, CMS guidelines, OIG restructuring, MAC/RAC/ZPIC audits, HIPAA, physician/coder training, and pay for performance measures. She serves on AAPC’s National Advisory Board, representing Region 4.

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