Hospital quality teams aspire to formulate plans that exert impact over CMS Star Ratings, necessitating both short-term and long-term strategies. A sustainable, long-term game plan would likely encompass comprehensive, AI-driven simulations to comprehend the most effective path towards an enhanced star rating. Nevertheless, hospitals might also encounter pressure to yield results in the short term.
Positioned at the commencement of 2024, it's pivotal to examine which measures can be impacted for the CMS Star Ratings in 2025 and 2026, and to what extent.
Key Takeaways from the Subsequent Table:
2025 Star Ratings Focus: Limited modifications can be enacted given that only 25% of the relevant time period remains, specifically for Hospital Acquired Infections (HAI) and the HCAHPS (Patient Experience).
2026 Star Ratings Focus: Concentration could be allocated towards HAI and HCAHPS, as 100% of the time frame for influencing these variables is still available.
It's crucial to keep in mind that improvements in CMS Star Ratings require a steadfast, multi-year effort to elevate ratings. Consequently, elements such as Readmissions and Mortality cannot be disregarded in the pursuit of maintaining high-performance standards.
| Measure Name | Group | 2025 CMS Star Rating Time Period | 2025 % of Potential Time Period to be Impacted from Jan 1 2024 | 2026 CMS Star Rating Time Period | 2026 % of Potential Time Period to be Impacted from Jan 1 2024 |
|---|---|---|---|---|---|
| MORT-30-AMI (AMI- 30-day Mortality Rate) | Mortality | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| MORT-30-CABG (CABG-30-day Mortality Rate) | Mortality | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| MORT-30-COPD (COPD-30-day Mortality Rate) | Mortality | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| MORT-30-HF (HF-30-day Mortality Rate) | Mortality | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| MORT-30-PN (Pneumonia -30-day Mortality Rate) | Mortality | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| MORT-30-STK (Stroke 30-day Mortality Rate) | Mortality | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| PSI-4-SURG-COMP (Death rate among surgical inpatients with serious treatable complications) | Mortality | July 2021 to June 2023 | 0% | July 2022 to June 2024 | 25% |
| EDAC-30-AMI (AMI - Excess Days in Acute Care) | Readmission | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| READM-30-CABG (CABG - Surgery 30-day Readmission Rate) | Readmission | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| READM-30-COPD (COPD- 30-day Readmission Rate) | Readmission | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| EDAC-30-HF (HF - Excess Days in Acute Care) | Readmission | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| READM-30-Hip-Knee (30-day readmission rate following elective primary THA and/or TKA) | Readmission | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| EDAC-30-PN (PN - Excess Days in Acute Care) | Readmission | July 2020 to June 2023 | 0% | July 2021 to June 2024 | 16% |
| READM-30-HOSP-WIDE (30-day hospital-wide all- cause unplanned readmission (HWR) | Readmission | July 2022 to June 2023 | 0% | July 2022 to June 2024 | 25% |
| OP-32 (Rate of unplanned hospital visits after colonoscopy) | Readmission | Jan 2021 to Dec 2023 | 0% | Jan 2022 to Dec 2024 | 33% |
| OP-35 ADM (Rate of inpatient admissions for patients receiving outpatient chemotherapy) | Readmission | Jan 2023 to Dec 2023 | 0% | Jan 2024 to Dec 2024 | 100% |
| OP-35 ED (Rate of emergency department (ED) visits for patients receiving outpatient chemotherapy) | Readmission | Jan 2023 to Dec 2023 | 0% | Jan 2024 to Dec 2024 | 100% |
| OP-36 (Ratio of unplanned hospital visits after hospital outpatient surgery) | Readmission | Jan 2023 to Dec 2023 | 0% | Jan 2024 to Dec 2024 | 100% |
| HAI-1 (Central-Line Associated Bloodstream Infection (CLABSI) | Safety of Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| HAI-2 (Catheter-Associated Urinary Tract Infection (CAUTI) | Safety of Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| HAI-3 (Surgical Site Infection from Colon Surgery (SSI-colon) | Safety of Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| HAI-4 (Surgical Site Infection from Abdominal Hysterectomy (SSI-abdominal hysterectomy) | Safety of Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| HAI-5 (MRSA Bacteremia) | Safety of Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| HAI-6 (C.difficile) | Safety of Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| COMP-HIP-KNEE (Hospital-Level Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) | Safety of Care | April 2020 to March 2023 | 0% | April 2021 to March 2024 | 25% |
| PSI-90-Safety (Patient Safety and Adverse Events Composite) | Safety of Care | July 2021 to June 2023 | 0% | July 2022 to June 2024 | 25% |
| H-COMP-1 (Communication with Nurses) | Patient Experience | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| H-COMP-2 (Communication with Doctors) | Patient Experience | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| H-COMP-3 (Responsiveness of Hospital Staff) | Patient Experience | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| H-COMP-5 (Communication about Medicines) | Patient Experience | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| H-COMP-6 (Discharge Information) | Patient Experience | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| H-COMP-7 (Care Transition) | Patient Experience | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| H-CLEAN-HSP / H-QUIET-HSP (Cleanliness and Quietness of Hospital Environment) | Patient Experience | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| H-HSP-RATING / H-RECMND (Overall Rating of Hospital) | Patient Experience | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| OP-8 (MRI lumbar spine for low back pain) | Timely & Effective Care | July 2022 to June 2023 | 0% | July 2023 to June 2024 | 50% |
| OP-10 (Abdomen CT - use of contrast material) | Timely & Effective Care | July 2022 to June 2023 | 0% | July 2023 to June 2024 | 50% |
| OP-13 (Cardiac imaging for preoperative risk assessment for non-cardiac low-risk surgery) | Timely & Effective Care | July 2022 to June 2023 | 0% | July 2023 to June 2024 | 50% |
| OP-3b (Median time to transfer to another facility for acute coronary intervention) | Timely & Effective Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| OP-18b (Median time from emergency department arrival to emergency department departure for discharged patients) | Timely & Effective Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| IMM-3 (Influenza vaccination coverage among healthcare personnel) | Timely & Effective Care | October 2023 to March 2024 | 25% | October 2024 to March 2025 | 100% |
| OP-22 (Left without being seen) | Timely & Effective Care | Jan 2023 to Dec 2023 | 0% | Jan 2024 to Dec 2024 | 100% |
| OP-23 Head CT scan results for stroke who received head CT scan interpretation within 45 minutes of arrival) | Timely & Effective Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| OP-29 (Appropriate follow-up interval for normal colonoscopy in average risk patients) | Timely & Effective Care | Jan 2023 to Dec 2023 | 0% | Jan 2024 to Dec 2024 | 100% |
| PC-01 (Elective delivery prior to 39 completed weeks of gestation) | Timely & Effective Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| SEP-1 (Early management bundle, severe sepsis/septic shock) | Timely & Effective Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| OP-2 (Fibrinolytic Therapy Received Within 30 Minutes of ED Arrival) | Timely & Effective Care | April 2023 to March 2024 | 25% | April 2024 to March 2025 | 100% |
| HCP_COVID_19 (Percentage of healthcare personnel who completed COVID-19 primary vaccination series) | Timely & Effective Care | Jan 2024 to March 2024 | 25% | Jan 2025 to March 2025 | 100% |