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Determining the value proposition of surgical care in CMS star rated hospitals

Published:November 17, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.11.022

      Highlights

      • The Centers for Medicare and Medicaid Services “Star” rating, typically seen as a proxy for quality, is also indicative of value of care delivered.
      • In a colectomy model, 1- and 5- Star hospitals have functionally equivalent total costs, meaning the 5-Star hospitals deliver excellent value.
      • In a propensity matched comparison, 1- and 5- Star hospitals differ in that 5-Star hospitals have a lower length-of-stay, higher operating costs, and higher medical and surgical supply costs.

      Abstract

      Background

      CMS Hospital Quality Star ratings reflect the quality of care given to patients. It is hypothesized that increased Star-rating is associated with higher cost and that the value proposition is diminished.

      Methods

      This study used the Florida AHCA inpatient dataset, CY2019. Partial colectomy was selected as a representative inpatient surgical procedure. Analysis was performed on this data to compare high and low Star-rated hospitals.

      Results

      Total costs were equivalent among all Star levels on initial analysis. In a propensity matched comparison with 1 Star, 5 Star hospitals had significantly lower length-of-stay and ICU, anesthesia, radiology and lab costs, and conversely, had higher total (+2%), operating room and med-surg supply costs.

      Conclusions

      These results demonstrate that total colectomy costs are functionally equivalent among the CMS 1- and 5- Star categories. The results indicate that higher CMS Star ratings fulfill the value proposition and indeed offer higher quality without significantly increased cost.

      Keywords

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