89: Variation in Postoperative Outcomes Across CMS Hospital Star Ratings for complex Cancer Surgery

Saturday, March 25, 2023

10:06 AM – 10:16 AM

Location: Ballroom B

Abstract Presenter(s)

Adrian Diaz, MD (he/him/his)

Clinical Housestaff
The Ohio State University
Columbus, Ohio, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

Adrian Diaz, MD (he/him/his)

Clinical Housestaff
The Ohio State University
Columbus, Ohio, United States

Disclosure(s): No financial relationships to disclose

Author(s)

UN

Usha Nuliyalu, MPH

Senior Statistician
University of Michigan, United States

Disclosure information not submitted.
NK

Nick Kunneth, MPH

Statistician
University of Michigan, United States

Disclosure information not submitted.
JD

Justin Dimick, MD MPH

Professor
University of Michigan, United States

Disclosure information not submitted.
AI

Andrew Ibrahim, MD MPH

Professor
University of Michigan, United States

Disclosure information not submitted.
Hari Nathan, MD, PhD, FACS, FSSO (he/him/his)

Associate Professor of Surgery and Chief, Division of Hepato-Pancreato-Biliary Surgery
University of Michigan
Ann Arbor, Michigan, United States

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Adrian Diaz, MD: No financial relationships to disclose

Hari Nathan, MD, PhD, FACS, FSSO: No financial relationships to disclose

Introduction: In an attempt to provide a single public measure of hospital quality, the Centers for Medicare & Medicaid Services introduced the Overall Hospital Quality Star Rating program. However, whether hospital star ratings are associated with postoperative outcomes for complex cancer operations and therefore a reliable measure of hospital quality for the public remains unknown.

Methods: We performed a cross-sectional review of 335,829 Medicare beneficiaries undergoing one of four procedures for cancer between 2016-2020. Hospitals (n=2,965) were stratified by their Star Rating. The primary outcome was a composite of death or a serious postoperative complication. We then calculated Risk- & Reliability adjusted hospital mortality or serious complication rates. Finally, we analyzed the variation in outcomes within and across Star Ratings.

Results: Overall, risk- and reliability adjusted hospital mortality/serious complication rate was 8.3%(SD:1.7) and ranged from 3.3% to 20.0%. Hospital mortality/serious complication rate decreased in a stepwise fashion from 8.9%(SD: 1.9) at one-star hospitals to 8.6%(SD:1.7) at two-star hospitals, 8.4%(SD:1.7) at three-star hospitals, 8.1%(SD:1.5) at four-star hospitals, and 7.8%(SD:1.5) at five-star hospitals. There was wide variation in mortality across (6.26x) and within star ratings. Specifically, one-star hospital mortality varied by 3.85x, two-star hospitals varied 5.15x, three-star hospitals varied 4.93x, four-star hospitals varied 4.56x, and five-star hospitals varied 3.32x. In sensitivity analysis of each of the 20 highest-volume metropolitan areas, within only five areas did five-star hospitals have statistically better outcomes than a lower rated hospital.

Conclusions:

Although hospital star rating was associated with postoperative outcomes, there was wide variation in mortality across all hospitals and within each star rating group. These findings highlight the limitations of CMS’s star rating system and should be a call for continued improvement of publicly reports hospital grade measures.

Learning Objectives:

Assess whether quality star ratings are useful metrics for patients choosing a hospital
describe variation in outcomes within and across their network
list the limitations of hospital quality ratings