CMS 1-star hospitals had higher 30-day postoperative mortality than 5-star hospitals (6.80% vs 4.93%; adjusted OR 1.86, 95% CI 1.73-2.00), though wide variation existed within each star rating.
Cohort (n=1,898,829)
Yes
Does the CMS hospital star rating reliably reflect 30-day postoperative mortality, serious complications, and readmission rates in Medicare beneficiaries undergoing common surgeries?
Although higher CMS hospital star ratings are associated with better average surgical outcomes, wide intra-rating variation limits their reliability as a definitive measure of surgical quality for individual hospitals.
Odds Ratio: 1.86 (95% CI 1.73–2)
Absolute Event Rate: 6.8% vs 4.93%
Importance: Despite widespread use to guide patients to hospitals providing the best care, it remains unknown whether Centers for Medicare 95% CI, 1.73-2.00). There was wide variation in the rates of hospital mortality (variation, 1.89%; range, 2.4%-16.2%), serious complications (variation, 1.97%; range, 5.5%-45.1%), and readmission (variation, 1.27%; range, 9.1%-22.5%) across all hospitals. After stratifying hospitals by their star rating, similar patterns of variation were observed within star rating groups for 30-day mortality: 1 star (variation, 1.91%; range, 3.6%-12.0%), 2 star (variation, 1.86%; range, 2.8%-16.2%), 3 star (variation, 1.84%; range, 2.9%-12.3%), 4 star (variation, 1.76%; range, 2.9%-11.5%), and 5 star (variation, 1.79%; range, 2.4%-9.1%). Similar patterns were observed for serious complications and readmissions. Conclusion and Relevance: Although CMS hospital star rating was associated with postoperative mortality, serious complications, and readmissions, there was wide variation in surgical outcomes within each star rating group. These findings highlight the limitations of the CMS hospital star rating system as a measure of surgical quality and should be a call for continued improvement of publicly reported hospital grade measures.
Díaz et al. (Tue,) conducted a cohort in Surgical procedures (colectomy, CABG, cholecystectomy, appendectomy, incisional hernia repair) (n=1,898,829). CMS hospital star rating (1-star) vs. CMS hospital star rating (5-star) was evaluated on Risk- and reliability-adjusted 30-day postoperative mortality (adjusted OR 1.86, 95% CI 1.73-2.00). CMS 1-star hospitals had higher 30-day postoperative mortality than 5-star hospitals (6.80% vs 4.93%; adjusted OR 1.86, 95% CI 1.73-2.00), though wide variation existed within each star rating.