How to evaluate HCAHPS surveys with star ratings

While the data taken from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys to create Hospital Compare star ratings is primarily targeted at consumers to aid in their decision-making, it’s also an invaluable resource for hospitals.

Hospitals that want to remain competitive can use this data to inform and improve their processes and procedures. But first, they need to understand how the Centers for Medicare and Medicaid Services (CMS) calculates these ratings. They’ll then be better prepared to leverage this invaluable information to improve the quality of their services — as well as the patient experience.

How are HCAHPS star ratings calculated?

CMS uses HCAHPS survey questions, as well as Hospital Inpatient Quality Reporting Programs, to gather the data used to create the star ratings for each hospital nationwide.

The CMS analyzes this information using latent variable models. The CMS is particularly concerned with collecting data on what they’ve identified as important areas of care: 

  1. Mortality
  2. Safety of care
  3. Readmission
  4. Patient experience
  5. Effectiveness of care
  6. Timeliness of care
  7. Efficient use of medical imaging

These seven areas are all weighted. Each of the first four categories — mortality, patient safety, readmission rates, and patient experience — are allocated a weight of 22 percent each, because they are the areas many patients and physicians say they care about most. The remaining three categories — effectiveness of care, timeliness of care, and efficient use of medical imaging — are allocated a weight of 4 percent each.

Some hospitals may be missing data for one of these categories. In this case, the CMS adjusts the weights for the categories that they do have. 

The hospital’s summary score is the weighted average of its scores, and the star rating corresponds to this summary score. 

How to evaluate HCAHPS star ratings

The star rating system goes up from one to five stars — similar to consumer-friendly Yelp reviews — with one star being the lowest possible score. 

You can see which areas of focus need more work if you click on View rating details beneath the star rating for your hospital. This sub-report reveals whether you’re performing above, below, or at the same level as the national average in each of the seven categories of focus. 

According to Hospital Compare’s quarterly report released in January 2020, more than 400 hospitals out of over 4,500 hospitals received five stars. The most common star rating is three stars, with 1,119 hospitals receiving a three-star rating. However, it’s not easy to figure out how to achieve a five-star rating.

One thing hospitals with five-star ratings have in common is high scores in the four most heavily weighted measures, such as patient experience. 

But Deloitte’s report on the star ratings system concluded there is no single path to earning five stars. Although five-star hospitals often score well in a few of the four heavily weighted categories, they also have varying strengths and weaknesses across all seven areas of focus when compared to each other. 

According to Deloitte’s report, “The CMS designed the program to capture multiple aspects of quality and to offer a number of pathways for hospitals to achieve a 5-star rating. Based on service mix and patient caseloads, hospitals can have data on different combinations of quality measures and achieve a 5-star rating.”  

How to use star ratings results to improve your hospital

Since the four most heavily weighted categories account for 88 percent of the raw data and all five-star hospitals perform well in at least a few of these areas, the first step toward improving your hospital is to look at how you can improve in the mortality, patient safety, readmission rates, and patient experience areas.

  • If budget is a concern, prioritize areas where you already have the resources to make meaningful improvements.
  • Implement a new nurse communication strategy — a relatively low-cost measure aimed at creating a more positive patient experience.
  • Create a patient safety checklist, a cost-effective solution to help improve patient safety.
  • Prioritize quality improvements based on the unique needs of your hospital’s patient demographics. 
  • Conduct multiple, regular internal patient surveys that follow up on the CMS star ratings to direct you toward ways to improve.

While patient data plays a significant role in aggregating this information, don’t forget to think about measures patients may not see but that can still have an impact on your star rating, such as the safety protocols that prevent them from getting an infection in the hospital. It won’t occur to the patient to provide feedback in an HCAHPS survey on an infection they never got, but the steps you took to prevent it contribute to higher safety and mortality ratings. 

The goal of HCAHPS star ratings

The HCAHPS star ratings have a dual purpose — helping consumers choose the right hospital and challenging hospitals to work toward the highest possible standards of care throughout the year. The data from HCAHPS surveys can be easily dissected and used to inform your hospital’s improvement strategies. Building a strong culture of patient safety and satisfaction requires engaging stakeholders across the organization. Leadership on clinical quality measures should come from the C-suite, but input from physicians, administrators, and technicians — as well as regular feedback from patients — will provide useful insights that can aid you in your efforts to earn a prestigious five-star rating.

This article is originally published on May 31, 2020, and updated on Jun 09, 2020
Firm believer in personal data privacy in the age of information. Close follower of the new regulations concerning patient confidentiality & HIPAA. You can reach George through his contact form.

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