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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2020

01-09-2020 | Pancreatectomy | Health Services Research and Global Oncology

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

Authors: Rittal Mehta, MPH, BDS, Anghela Z. Paredes, MD, MS, Diamantis I. Tsilimigras, MD, Ayesha Farooq, MBBS, Kota Sahara, MD, Katiuscha Merath, MD, J. Madison Hyer, MS, Susan White, PhD, Aslam Ejaz, MD, Allan Tsung, MD, Mary Dillhoff, MD, Jordan M. Cloyd, MD, Timothy M. Pawlik, MD, MPH, PhD, FACS, FRACS (Hon.)

Published in: Annals of Surgical Oncology | Issue 9/2020

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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.
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Metadata
Title
CMS Hospital Compare System of Star Ratings and Surgical Outcomes Among Patients Undergoing Surgery for Cancer: Do the Ratings Matter?
Authors
Rittal Mehta, MPH, BDS
Anghela Z. Paredes, MD, MS
Diamantis I. Tsilimigras, MD
Ayesha Farooq, MBBS
Kota Sahara, MD
Katiuscha Merath, MD
J. Madison Hyer, MS
Susan White, PhD
Aslam Ejaz, MD
Allan Tsung, MD
Mary Dillhoff, MD
Jordan M. Cloyd, MD
Timothy M. Pawlik, MD, MPH, PhD, FACS, FRACS (Hon.)
Publication date
01-09-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 9/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-08088-y

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