On Dec 2, 2020, the Centers for Medicare and Medicaid Services (“CMS”) published finalized policies designed to overhaul the methodology used to calculate the Overall Hospital Quality Star Rating effective 2021 – CY 2021 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule” (the “Final Rule”).
CMS is now simplifying the methodology used to calculate this Star Ratings. The National Law Review writes certain features of the calculation, such as the annual refresh, the scope of included measures, standardization of measure scores, and the use of k-means clustering to assign a rating, will remain in place. However, whereas the Quality Star Ratings system previously categorized hospitals into seven process measure groups, the Final Rule combines three of these groups into a new “Timely and Effective Care” group. As a result, beginning in 2021, the Overall Star Ratings will be made up of five groups – Mortality, Safety of Care, Readmissions, Patient Experience, and Timely and Effective Care.