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Five-star rating systems seem to work fine for movies, books, restaurants, and hotels. It’s a simple way to compare the quality of one against others, and rank them in terms of personal preferences and generally accepted standards. But the very simplicity of this rating system can work against it in more complicated applications.

According to the American Hospital Association (AHA), the use of hospital star ratings by the Centers for Medicare & Medicaid Services (CMS) for the Hospital Compare program is an example of a complicated star rating application that fails to deliver accurate comparisons.

Star ratings remain less than stellar

Since 2015, before the implementation of the overall star rating system, the AHA has documented concerns with the underlying principles and methodologies of the system. The CMS has taken steps to revise their protocols, supported by input from the AHA and other stakeholder groups. However, some of the shortcomings in the process remain to be addressed.

Flawed methodology provides flawed results

The AHA focuses on flaws in the execution of the star rating methodology used by the CMS calculations. Problems identified include how statistical analysis methods are applied to the data collected in each of the hospital performance rating categories.

One such problem is the ‘smoothing’ effect that is built into the process of calculating aggregated performance scores. This has the effect of making organizations look more similar in the overall ratings than they actually are based on the data inputs. Another problem is that clinical specializations and other distinctions in patient care are hidden by the emphasis on overall hospital ratings.

AHA calls for suspension of star ratings

In arguing for further refinement to the Hospital Compare system, the AHA calls for a suspension of the use of star ratings until the methodology and underlying assumptions are proven by independent research to be an accurate and reliable measure of comparison.

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