Hospital ratings correlate with Ca surgery outcomes

Boston-Medicare beneficiaries who undergo major urologic cancer surgery at hospitals with higher Hospital Compare Star Ratings introduced by the Centers for Medicare & Medicaid Services (CMS) in 2016 have superior short-term outcomes than patients operated on at hospitals with lower Hospital Compare rating, according to data presented at the AUA annual meeting in Boston.

The finding suggests a potential role for these ratings in guiding choice of hospital for major cancer surgery, said lead investigator Deborah Kaye, MD.

“We were really surprised by these findings. We set out to say basically that these rankings mean nothing but then we had this finding, and we did multiple sensitivity analyses across everything we could possibly think of, and the results still came up that they correlated,” said Dr. Kaye, a urologic oncology fellow at the University of Michigan, Ann Arbor, working with David C. Miller, MD, MPH, and colleagues.

The best way for patients to determine where to obtain hospital-based care remains a topic of debate in the lay press and the scientific literature. The stated goal for CMS’ Hospital Compare Star Rating System is to help patients make more informed health care decisions.

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The program assigns hospitals a star rating ranging from 1 (lowest score) to 5 (highest score). The star rating system is a composite measure comprised of 64 possible measures based on seven health areas (general information, survey of patients’ experiences, timely and effective care, complications, readmissions and deaths, use of medical imaging, and payment and value of care). The summary score is a weighted average of each category. To receive a star rating, a hospital has to report a minimum of three measures in at least three categories, including one of the outcomes categories. CMS calculates a hospital star rating in only the measures on which the hospitals choose to report.

The ratings are publicly available on the Hospital Compare website (www.medicare.gov/hospitalcompare/).

“While the star ratings have the benefit of being publicly available, they have also been criticized as being inaccurate, and there’s little data to validate whether the star ratings reflect patient outcomes,” Dr. Kaye said.

Her group evaluated whether CMS’ Hospital Compare Star Rating is associated with short-term outcomes after major cancer surgery. They used national Medicare claims data from the American Hospital Association annual survey and CMS Hospital Compare data. Patients 66 to 99 years of age who underwent major prostate, bladder, or kidney cancer surgery from Jan. 1, 2011 through Nov. 30, 2013 were identified. The 4 surgical outcomes examined were the occurrence of 30-day rate of complications, 30-day mortality, the rate of 30-day readmissions, and prolonged length of stay.

Next: How the hospitals fared

Some 122,321 patients undergoing urologic surgery at 2,147 hospitals with a 1- to 5-star rating were identified. Star ratings were as follows:

• 1 star: 5% of hospitals

• 2 stars: 24%

• 3 stars: 44%

• 4 stars: 25%

• 5 stars: 3%.

These ratings corresponded roughly with patients’ ratings. A greater share of patients at 5-star hospitals was Caucasian, and patients managed at 5-star hospitals tended to have fewer comorbidities. Five-star hospitals were less likely to be located in the Northeast, were larger, were more likely nonprofit, and less likely to be a teaching hospital.

Outcomes differ between 1-, 5-star hospitals

In unadjusted analyses, a significant inverse association was observed between CMS star ranking and the occurrence of all four adverse outcomes. In adjusted analyses, the difference in all outcomes between 1-star and 5-star hospitals were significant, except for 30-day complication rates.

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The 30-day complication rate for 1-star hospitals was 34% compared with 28% for 5-star hospitals (p=.074), the 30-day readmission rate was 11% vs. 8% (p<.001), the 30-day mortality rate was 1.7% vs. 0.6% (p<.001), and prolonged length of stay was experienced by 6% vs. 3% (p<.001), respectively.

The relationship between outcome and star rating was fairly small, said Dr. Kaye, but could serve as a guide for patients who have no other information on which to base a choice.

“We identified similar relationships across individual procedures,” she said. “Additional research is required to determine whether the star rankings accurately reflect other star measures of quality of urologic cancer care.”

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