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CMS Hospital Compare System of Star Ratings and Surgical Outcomes Among Patients Undergoing Surgery for Cancer: Do the Ratings Matter?

  • Rittal Mehta
  • Anghela Z. Paredes
  • Diamantis I. Tsilimigras
  • Ayesha Farooq
  • Kota Sahara
  • Katiuscha Merath
  • J. Madison Hyer
  • Susan White
  • Aslam Ejaz
  • Allan Tsung
  • Mary Dillhoff
  • Jordan M. Cloyd
  • Timothy M. PawlikEmail author
Health Services Research and Global Oncology

Abstract

Background

The Centers for Medicare and Medicaid Services (CMS) Hospital Compare star rating system has been proposed as a means to assess hospital quality performance. The current study aimed to investigate outcomes and payments among patients undergoing surgery for colorectal, lung, esophageal, pancreatic, and liver cancer across hospital star rating groups.

Methods

The Medicare Standard Analytic Files (SAF) from 2013 to 2015 were used to derive the analytic cohort. The association of star ratings to perioperative outcomes and expenditures was examined.

Results

Among 119,854 patients, the majority underwent surgery at a 3-star (n = 34,901, 29.1%) or 4-star (n = 30,492, 25.4%) hospital. Only 12.2% (n = 14,732) were treated at a 5-star hospital. Across all procedures examined, patients who underwent surgery at a 1-star hospital had greater odds of death within 90 days than patients who had surgery at a 5-star hospital (colorectal, 1.41 [95% confidence interval {CI}, 1.25–1.60]; lung, 1.97 [95% CI 1.56–2.48]; esophagectomy, 1.83 [95% CI 0.81–4.16]; pancreatectomy, 1.70 [95% CI 1.20–2.41]; hepatectomy, 1.63 [95% CI 0.96–2.77]). A similar trend was noted for failure to rescue (FTR), with the greatest odds of FTR associated with 1-star hospitals. The median expenditure associated with an abdominal operation was $1661 more at a 1-star hospital than at a 5-star hospital (1-star: $17,399 vs 5-star: $15,738). A similar trend was noted for thoracic operations.

Conclusion

The risk of FTR, 90-day mortality, and increased hospital expenditure were all higher at a 1-star hospital. Further research is needed to investigate barriers to care at 5-star-rated hospitals and to target specific interventions to improve outcomes at 1-star hospitals.

Notes

Disclosures

There are no conflicts of interest.

Supplementary material

10434_2019_8088_MOESM1_ESM.docx (34 kb)
Supplementary material 1 (DOCX 34 kb)
10434_2019_8088_MOESM2_ESM.tiff (546 kb)
Scatter plot depicting outcomes for patients undergoing abdominal surgery stratified by star rating. (TIFF 546 kb)
10434_2019_8088_MOESM3_ESM.tiff (386 kb)
Scatter plot depicting outcomes for patients undergoing thoracic surgery stratified by star rating. (TIFF 386 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Rittal Mehta
    • 1
  • Anghela Z. Paredes
    • 1
  • Diamantis I. Tsilimigras
    • 1
  • Ayesha Farooq
    • 1
  • Kota Sahara
    • 1
  • Katiuscha Merath
    • 1
  • J. Madison Hyer
    • 1
  • Susan White
    • 1
  • Aslam Ejaz
    • 1
  • Allan Tsung
    • 1
  • Mary Dillhoff
    • 1
  • Jordan M. Cloyd
    • 1
  • Timothy M. Pawlik
    • 1
    Email author
  1. 1.Department of Surgery, Division of Surgical OncologyThe Ohio State University Wexner Medical CenterColumbusUSA

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