The Centers for Medicare & Medicaid Services (CMS) 5-Star Quality Rating system is often used as a public-facing indicator of the caliber of a hospital or health system. Comprised of 7 measure groups which influence Medicare market share and reimbursement, the Star Rating evaluates hospitals on key performance attributes including safety of care, readmission, and patient experience indicators.
Since the inception of the rating scale in 2016, CMS has strengthened the scoring methodology, placing increased impendence on hospital performance aligned to patient experience and access to care.
The Opportunity
An RTI Health Advance client, a singular hospital campus belonging to a larger, multi-site hospital system in the New York Metropolitan Area, has historically earned a 1-Star Rating on the CMS scale. As a safety-net hospital that was heavily engaged in the COVID-19 response, the hospital cared for an impoverished patient population impacted by many social determinants of health (SDoH).
Operationally, the hospital worked to stabilize constraints, such as limited financial resources and high team member burn-out and staff turnover resulting from the pandemic.
Our Approach
Our team engaged with the client to help transform their clinical quality improvement efforts to better serve their patient population, align to operational goals, and enhance their annual Star Rating performance.
Our team employed a multi-faceted approach to understand:
- The perspective held by the health system's operational and leadership on the CMS Star Rating
- The quality improvement initiatives being conducted by the hospital to improve patient health outcomes
- The data analytic capabilities possessed within the functional areas of the health system
Stakeholder Insights
Our team conducted key stakeholder interviews to identify internal considerations, interventions, and constraints impacting the current Star Rating performance. The stakeholder interviews focused on:
- Data availability, dissemination, and use
- Community partnerships and team cross collaboration
- Clinical quality transformation efforts
- Governance processes for clinical quality or other implementation efforts
Data Evaluation
Our health economists partnered with the client's analytical team members to identify data availability, data sources, quality performance dashboards, and historic performance on high-impact CMS Star quality metrics. We developed a deep understanding of how data is exchanged throughout the organization and identified how actions impacted their Star Rating performance.
Findings
We evaluated industry best practices to generate tailored recommendations aligned to the client's business model and goals identified during key stakeholder interviews. Based on our findings, we created a performance improvement roadmap to support the client's immediate action toward process improvement.
Accounting for each CMS Star measure group, the RTI Health Advance team evaluated current performance and offered a tailored menu of interventions that the client can implement to improve high-impact clinical quality indicators.
Outcomes
We supplied the client with an evidence-based roadmap to provide the highest quality of care for their patient population and support a favorable improvement in their CMS Star Rating performance. Based on these insights, the client developed:
- A heightened awareness of day-to-day clinical processes that have a direct impact on CMS Star measure indicators and outcomes
- Innovative strategies to optimize community and intra-hospital partnerships on network-wide initiatives for improved outcomes
- An enhanced strategy for data collection and transparency to reduce operational burden to support timely, proactive performance improvement efforts
- Clarity on high-priority CMS Star measure groups and indicators in need of heightened intervention to meet the operational goals and improve the CMS Star Rating