CMS Star Rating Analytics and Monitoring by Dexur

CMS has implemented a 5-star rating system to evaluate the experiences medicare beneficiaries have with their healthcare service providers. The hospitals are rated on a scale of 1 to 5, with 5 being the highest. While there are no financial incentives linked to the program, the rating determines the reputation of hospitals, and patients are motivated to go with the hospitals that have the highest rating. Following are the five measure groups, with each one contributing a different percentage to the overall rating:

  1. Mortality
  2. Readmissions
  3. Safety of Care
  4. Patient Experience
  5. Timely and Effective Care

Readmissions and Mortality measures together constitute 44% of the overall CMS Star Rating. Dexur’s research, based on Real World Evidence (RWE), identifies various Micro Cohorts with a higher risk for Readmissions and Mortality and provides best practises that can reduce these cohort rates to improve the Hospital Star Rating.

CMS Star Ratings Slide1

Dexur charts hospitals’ latest and previous years’ value against the national average and median to evaluate current performance. Cohort median comparison and upper and lower quartile values are also shown to provide a comprehensive understanding of the hospital’s performance.

CMS Star Ratings Slide2

The star ratings are derived after replication of complex CMS algoritms related to multiple measures involved. Dexur meticulously calculates each measure under different measure groups and provides data through multiple years. Hospitals can assess this data and narrow down measures that are driving the points.

CMS Star Ratings Slide3