Do CMS Ratings Punish Hospitals for Serving the Poor?

Does the CMS star rating system reward hospitals for serving the affluent and punish those that serve the poor?  The answer is a resounding yes, according to a recently published analysis by Bloomberg BNA.  The analysis compared star ratings of hospitals across the country with U.S. Census Bureau data for each hospital’s service area.  The result was an undeniable positive correlation between high star ratings and high household income, and a corresponding correlation between low ratings and low income.

The conclusion doesn’t come as a surprise.  Most hospital trade groups had predicted it from the day the star-rating system was first announced; so had Congressmen representing low-income districts.

Critics of the rating system point out that low-income patients are more likely to have difficulty accessing transportation for both routine primary care and post-discharge follow-up care.  That can and does affect readmission rates, which are a key component of quality ratings.

Critics of the system also point to anomalous results such as the consistently low ratings of academic medical centers, which are generally considered among the nation’s best hospitals and which are often located in low income urban areas.  Two outstanding examples are George Washington University Hospital and Georgetown University Hospital, both in the District of Columbia and both with the lowest star rating possible.

Bloomberg BNA published the report on September 16.

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