Life Science Compliance Update

May 20, 2015

Hospital Compare Update: CMS Adds Star System Rating Patient Experience

Hospital Compare

Hospital Compare is, according to CMS, a “consumer-oriented website that provides information on how well hospitals provide care to their patients.” The website relies on data gleaned from the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, survey, to measure patients’ perspectives of the hospital care they receive. Just last month, CMS introduced a star rating system to its Hospital Compare website, in order to “provide a quick summary of each HCAHPS measure in a format that is increasingly familiar to consumers and enable consumers to more quickly and easily assess the patient experience of care information.” CMS clarifies that the new Star Ratings summarize only one aspect of hospital quality: patients’ experience of care. The Hospital Compare website tracks other metrics as well, but the "patient experience" prong is the first to get the star rating treatment. CMS plans to update the ratings each quarter.

The first public reporting of the HCAHPS Star Ratings published last month is based on patients discharged between July 1, 2013 and June 30, 2014. HCAHPS Star Ratings, including the star ratings level thresholds, will be recalculated for each public reporting. 

Hospital Compare

In addition to patient experience, Medicare’s Hospital Compare currently rates hospitals on a wide variety of metrics, including: timely and effective care; readmissions, complications, and deaths; use of medical imaging; payment and value of care; and number of Medicare patients.

Hospital Compare

Hospital Compare lists the results from its “Consumer Assessment,” a national survey that asks patients about their experiences during a recent hospital stay.

The website lists a percentage next to the following eleven questions:

  1. Patients who reported that their nurses "Always" communicated well
  2. Patients who reported that their doctors "Always" communicated well
  3. Patients who reported that they "Always" received help as soon as they wanted
  4. Patients who reported that their pain was "Always" well controlled
  5. Patients who reported that staff "Always" explained about medicines before giving it to them
  6. Patients who reported that their room and bathroom were "Always" clean
  7. Patients who reported that the area around their room was "Always" quiet at night
  8. Patients who reported that YES, they were given information about what to do during their recovery at home
  9. Patients who "Strongly Agree" they understood their care when they left the hospital
  10. Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)
  11. Patients who reported YES, they would definitely recommend the hospital

CMS has now consolidated the percentages to these eleven questions into a "Summary Star Rating" scale from 1 star to 5 stars. CMS created the HCAHPS Star Ratings to enable consumers to more quickly and easily assess the patient experience of care information that is provided on the Hospital Compare website. "Star ratings will also allow consumers to more easily compare hospitals," CMS states.

More Ratings in the Future

"In addition to adding HCAHPS Star Ratings to Hospital Compare in April 2015, CMS is developing a methodology for an overall hospital star rating that includes the full range of quality measures reported on Hospital Compare," state CMS. "We believe that an overall hospital rating will be helpful to consumers by allowing them to more easily compare the quality provided by hospitals." 

CMS already uses star ratings in other Compare websites, as well as in Medicare Plan Finder. Currently, Nursing Home Compare features an overall star rating for each facility and star ratings for other important categories of health care quality. In 2014, CMS introduced star ratings to Physician Compare, which uses them to rate a limited number of measures for group practices. In January 2015, CMS added star ratings to Dialysis Facility Compare and plans to add them to Home Health Compare later this year. Medicare Plan Finder uses star ratings to help beneficiaries select parts C and D plans. These star ratings also determine quality bonus payments for plans.


Condensing a hospital's perceived worth down to a 1-5 star rating has caused some in the healthcare industry to question the methodology of CMS's metrics, or at least the value they have for patients seeking quality care. The American Hospital Association, for example, questioned the value of the star ratings. “The reasons that patients seek care from hospitals are varied,” said Akin Demehin, the AHA's senior associate director of policy (see Modern Healthcare). “We are not confident that a star-rating approach—especially one that would encompass all of the measures on Hospital Compare and roll them up into a single overall star rating—is going to give patients the insight on the quality of their hospitals that CMS is hoping for.”

Other articles have questioned whether CMS's rating system is using accurate information for their grades. For their part, CMS urges those using the information to consider multiple factors, including other Hospital Compare metrics, when choosing a hospital. A patient's satisfaction level regarding a nurse's communication skills is important, but those survey results should be paired with patient health outcomes, for example, such as readmission, complication, and mortality rates

Modern Healthcare found that only about 7 percent of hospitals received a 5-star rating, and 19 percent of hospitals received either a 1 or 2. Most received either 3 stars (40 percent) or 4 stars (34 percent). Their article also lists in order of stars, every hospital listed on CMS's website. 

May 07, 2015

Over 500 Organizations Urge Congress to Repeal ACA's Independent Payment Advisory Board (IPAB)

  Healthcare reform

In an effort to curtail the rise in Medicare cost, the Affordable Care Act established the Independent Payment Advisory Board (IPAB), which would consist of 15 presidentially appointed members tasked with proposing Medicare cuts if spending growth exceeded certain inflation-based projections. IPAB has been the root of a fair deal of controversy, with opponents criticizing the provision for giving too much power to “15 unelected, unaccountable bureaucrats.” Others have termed the IPAB a “death panel,” given their power over Medicare reimbursements and ability to essentially ration care.

Despite the opposition, IPAB hasn’t been an active issue because Medicare spending has not continued to rise at a high rate over the last few years. In January, Modern Healthcare reported that “[n]ews about the 15-member panel, whose members have yet to be named, quietly reappeared last week when Congress agreed to reduce $10 million in funding for IPAB in the 2014 omnibus spending bill.” The provisions for IPAB come into effect if certain per capita spending surpasses certain targets, and “Medicare spending per enrollee grew just 0.7% in 2012, even slower than the 2.5% growth rate in 2011.”

Indeed, the IPAB seemed to have been lost amidst other healthcare news—including the repeal of SGR and insertion of new quality payment metrics.

However, yesterday, over 500 organizations wrote a letter to Congress to repeal the IPAB provisions of the Affordable Care Act. The organizations wrote that they found IPAB “not only poses a threat to that access but also, once activated, will shift healthcare costs to consumers in the private sector and infringe upon the decisionmaking responsibilities and prerogatives of the Congress.”

The letter to Congress states that an unelected board without adequate oversight or accountability would be taking actions historically reserved for the public’s elected representatives in the U.S. House and Senate.

The letter notes that once in place, IPAB must achieve mandated savings within a one-year time frame. Instead of pursuing long-term reforms to strengthen Medicare, IPAB would be more likely to achieve its targets by cutting payments to healthcare providers, the letter argues

“This would be devastating for patients, affecting access to care and innovative therapies,” the groups wrote, pointing out that the number of physicians unable to accept new Medicare patients due to low reimbursement rates has been increasing. “IPAB-generated payment reductions would only increase the access difficulties faced by too many Medicare beneficiaries. Furthermore, payment reductions to Medicare providers will almost certainly result in a shifting of health costs to employers and consumers in the private sector.”

The letter concludes: “We strongly support bringing greater cost-efficiency to the Medicare program. We also advocate continuing efforts to improve the quality of care delivered to Medicare beneficiaries. The Independent Payment Advisory Board will achieve neither of these objectives and will only weaken, not strengthen, a program critical to the health and well-being of current and future beneficiaries.”

The letter echoes the American Medical Association’s (AMA) concerns with the IPAB. “While some applaud the new advisory board as a mechanism for controlling health care costs outside the influence of political processes and pressures,” AMA states, “others have criticized the scope of its authority and the lack of flexibility in its mandate.” AMA has stated that they “continue[ ] to fight for the elimination of the Independent Payment Advisory Board, which will impose arbitrary across-the-board cuts to physicians and other providers.”

Legislation to repeal the board sponsored by Reps. Phil Roe (R-Tenn.) and Linda Sánchez (D-Calif.) has 222 co-sponsors, including 19 Democrats, reports The Hill

March 13, 2015

OIG Issues 2015 Health Reform Oversight Plan


HHS-OIG recently released their 2015 Health Reform Oversight Plan. The agency plans to hone in on the Affordable Care Act during 2015, with “primary focus” on the health insurance marketplaces. 

Health Insurance Marketplaces

OIG’s Oversight Plan states that their marketplace work will aim to answer questions in four key areas:

Payments: Are taxpayer funds being expended correctly for their intended purposes?

OIG plans on continuing their oversight into the accuracy and appropriateness of Federal expenditures with reviews of Financial Assistance Payments; Consumer Operated and Oriented Plan (CO-OP) Loan Program; Establishment grants; Navigator grants, and payments to Federal contractors.

Eligibility: Are the right people getting the right benefits?

To ensure accuracy in eligibility determinations, OIG is conducting reviews of marketplace enrollment safeguards, eligibility verifications for premium tax credits, and resolution of inconsistencies in federally facilitated Marketplace (FFM) applicant data. Further, OIG states that they are considering new work on emerging issues, such as Marketplaces’ verification of employer information. “We may also review eligibility for hardship waivers if that emerges as a significant issue as this year’s tax season progresses,” they state. Additional areas for oversight might include reviews of the second open enrollment period.

Management and Administration: Is HHS managing and administering Marketplace programs effectively and efficiently?

To assess the management and administration of Marketplace programs, OIG is currently reviewing HHS’s management and implementation of the FFM from enactment of the ACA through the second open enrollment period and continued oversight of Federal contractors.

Security: Is consumers’ personal information safe?

OIG’s security focused reviews include assessing FFM security controls over consumer information, including personally identifiable information. OIG will also review information security controls at selected State-based Marketplaces. OIG states they are working closely with HHS and law enforcement partners in other agencies to monitor for reports of cybersecurity threats and consumer fraud incidents and take appropriate investigative actions

Health Reform in Other HHS Programs

“Although we are devoting substantial attention to the Marketplaces…OIG is also conducting and developing oversight work addressing reforms in other programs,” their report states. These include Medicaid expansion and services, Medicare payment and delivery reform, Medicare and Medicaid program integrity, and public health programs.

Under the Medicare and Medicaid Program Integrity work, OIG states that they “are examining the implementation and effectiveness of provisions of Title VI of the ACA designed to strengthen transparency and program integrity in Medicare and Medicaid,” including reviews of enhanced provider screening systems, provider payment suspensions, provider terminations, and managed care encounter data.

OIG also states: “We will consider oversight of CMS’ new Open Payments Database and other Title VI transparency initiatives.”


Target Timeframes for Issuing Reports on Ongoing Marketplace Work

Winter 2015: OIG looks to be focused on payments in the early part of 2015:

  • Accuracy of Aggregate Payments to Qualified Health Plan Issuers for Advanced Premium Tax Credits and Cost Sharing Reductions, and Effectiveness of Related Internal Controls (Payments)
  • Payments to Federally Facilitated Marketplace Contractors (Payments)
  • Information System Security Controls at State-Based Marketplaces – CA (Security)
  • Review of Affordable Care Act Establishment Grants for State Marketplace – MD (Payments)
  • Programmatic Justification for CMS’ Involvement in Premium Tax Credit Obligations Under the ACA (Payments)

Spring 2015:

  • CMS’ Internal Controls Over Advance Premium Tax Credit Obligations and Payments Under the ACA (Payments)
  • Oversight of Federally Facilitated Marketplace Contractors (Management and Administration)
  • Review of Affordable Care Act Establishment Grants for State Marketplaces (Payments)
  • CO-OP Loan Program-Eligibility Status and Use of Startup and Solvency Loans – 6-month period (Payments)
  • Enrollment Safeguards at Additional State Marketplaces (Eligibility)
  • Information System Security Controls at State-Based Marketplaces – CO (Security)
  • CMS Implementation of Security Controls Over Consumer Information Obtained in the Federally Facilitated Marketplace (Security)
  • Review of the Federally Facilitated Marketplace’s Eligibility Verifications for Premium Tax Credits (Eligibility)

Summer 2015:

  • Implementation of the Federally Facilitated Marketplace (Case Study) (Management and Administration)
  • CO-OP Loan Program-Eligibility Status and Use of Startup and Solvency Loans – 12-month period (Payments)

Fall 2015:

  • Review of Grant Awards to Navigators in Federally Facilitated or State Partnership Marketplaces (Payments)
  • Information System Security Controls at State-Based Marketplaces – NY (Security)

 View the entire report here



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