The Center for Medicare and Medicaid Services' "Star Rating" system compares the quality of care of hospitals, rating hospitals with one to five stars based on 62 measurements such as mortality, readmissions, and patient experience. While not exactly like a Yelp review, this system is supposedly in place to help patients decide which hospitals best fit their medical needs. But does it actually do that? Some people think otherwise.
New research published in JNCI Cancer Spectrum reports a significant disparity in mortality rates for complex cancer procedures in one-star hospitals versus five-star hospitals. The findings speak to broader underlying disparities in healthcare that have been made evermore evident by the COVID-19 pandemic.
In conducting this study, the team analyzed data from 105,823 patients who underwent complex cancer procedures at 3,146 hospitals between 2013 and 2016. The group included patients over 65 years old with a diagnosis of cancer of the lung, colon, stomach, esophagus, or pancreas. The research found that mortality rates for complex cancer procedures in one-star hospitals are as high as 10.4% while five-star hospitals show rates of 6.4%.
"For complex cancer care, choosing the right hospital may be as important as choosing the right treatment.," said Daniel Boffa. "In order for patients to select the best hospital for their situation, they need access to understandable information regarding the safety and quality of hospital care. Unfortunately, the CMS star-rating system, while clear and easy to access, does not appear to distinguish the safest from the least safe hospitals with enough separation to reliably guide cancer patient choice for complex surgical care."
Additionally, the research team says that the overall effectiveness of the star rating system in helping patients choose hospitals for complex cancer surgeries appears to be modest. As the authors write, “Reassignment of patients from 1-star to 5-star hospitals (7.8% of patients) was predicted to save 84 Medicare beneficiaries each year. This impact varied by the procedure (colectomy: 47 lives/year to gastrectomy: 5 lives/year). Overall, 2,189 patients would have to change hospitals each year to improve outcomes (26 patients moved to save one life).”
So what are the other options that patients have? Scientists are still trying to figure that out.