Assessing Hospital Quality Scores By Proportion Of Patients Dually Eligible For Medicare And Medicaid

The Centers for Medicare and Medicaid Services has been reporting hospital star ratings since 2016. Some stakeholders have criticized the star ratings methodology for not adjusting for social risk factors. We examined the relationship between 2021 star rating scores and hospitals' proportion of Medicare patients dually eligible for Medicaid. We found that, on average, hospitals caring for a greater proportion of dually eligible patients had lower star ratings, but there was significant overlap in performance among hospitals when we stratified them by quintile of dually eligible patients. Hospitals in the highest quintile (those with the greatest proportion of dually eligible patients) had the best mean mortality scores (0.28) but the worst readmission (-0.44) and patient experience (-0.78) scores. We assigned star ratings after stratifying the readmission measure group by proportion of dually eligible patients and found that a total of 142 hospitals gained a star and 161 hospitals lost a star, of which 126 (89 percent) and 1 (<1 percent) were in the highest quintile, respectively. Adjusting public reporting tools such as star ratings for social risk factors is ultimately a policy decision, and views on the appropriateness of accounting for factors such as proportion of dually eligible patients are mixed, depending on the organization and stakeholder.

Automated summary

The Centers for Medicare and Medicaid Services has been reporting hospital star ratings since 2016, but stakeholders have criticized the methodology for not considering social risk factors. Our study found that hospitals with a higher proportion of dually eligible patients tended to have lower star ratings. However, there was a significant overlap in performance among hospitals when stratified by the proportion of dually eligible patients. The decision to adjust public reporting tools like star ratings for social risk factors is a policy decision, and opinions on the appropriateness vary among organizations and stakeholders.