‘No Stars’ Doesn’t Mean ‘Low Stars’: Rural Hospitals More Likely to Be Unrated
Rural hospitals are nearly three times more likely than urban hospitals to lack a rating from the Centers for Medicare & Medicaid. That could lead to consumer confusion about the quality of care those facilities offer, UNC researchers say.
The national hospital ranking system may be misleading patients about the quality of care they can expect to receive at rural medical facilities, according to researchers at the University of North Carolina at Chapel Hill.
That’s because rural hospitals are nearly three times more likely than urban ones to lack a rating, which could lead consumers to think rural hospitals were “hiding something” or had received a rating of zero. In fact, the researchers said, smaller hospitals were less likely to have enough cases to generate the data used in the rating system.
For the past four years, the federal Centers for Medicare & Medicaid have released ratings for about 4,600 U.S. hospitals. Five stars is the highest level, and one is the lowest.
The rating system is complex and covers up to 64 different criteria. If a hospital doesn’t supply at least nine measurements, it doesn’t receive a rating. Rural hospitals tend to have less data to report, perhaps because of small size or lack of a sufficient number of cases, and that makes them more likely to be left out of the rating system.
“Rural hospitals are disproportionately affected by the minimum reporting requirements, and while [the Centers for Medicare & Medicaid] cautions that the absence of a rating does not mean that a hospital provides low quality care, some consumers still may equate no rating with failure to report or with poor quality,” according to the report, which was written by five scholars at the North Carolina Rural Health Research and Policy Analysis Center at UNC.
Generally, the smaller the hospital, the more likely it was to be left out of the rankings. More than half of all Critical Access Hospitals, or CAH, did not receive a rating in the most recent report. CAHs generally have no more than 25 beds and are far from other medical facilities.
Hospitals with smaller budgets also were more likely to lack a rating. More than 70 percent of hospitals with net patient revenue of less than $20 million were not rated. With hospitals with net patient revenue of more than $50 million, 97 percent were rated.
The West had the highest percentage of unrated hospitals – 49 percent versus 11 percent unrated in the Northeast.
“It is important for consumers, policy makers, and other stakeholders to know that the disproportionate amount of missing data limits the conclusions that can be drawn from comparisons of the rural hospital quality star ratings” the report said.
“It is also important for consumers to avoid automatically interpreting no stars as zero stars (low quality) or a signal that a hospital is ‘hiding something.’”