Background: Centers for Medicare and Medicaid Service (CMS) publicly report patient experience star ratings for hospitals generated from their performance on the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) survey. The objective was to make the information more understandable for patients. However, the ratings may not be intuitive or help consumer choice. For example, in the hotel industry higher star rating is linked to provision of broader set of services. It is unclear if this is the case with hospitals. We examined which services might be unavailable to patients choosing 5-star facilities for their care.
Methods: National HCAHPS based hospital patient experience star rating data were linked with American Hospital Association (AHA) data on hospital characteristics for 2014. The proportion of 5-star hospitals without specific clinical services was calculated. Similarly, proportions of all hospitals with the same clinical services absent were calculated. Additionally, the number of bed types and number of procedures performed within a service line for 5-star summary rated hospitals were compared with all the hospitals using Student t-test.
Results: Only 150 (5.3%) hospitals received a 5-star patient experience rating. Patients who chose these hospitals will often have restricted themselves to a hospital with fewer services. 5-star hospitals more often did not have ED services, ICU care, cardiology services and neurology services compared to the full sample (P<0.001) (Figure 1). This remained true when specialty hospitals were excluded from analysis. Even when these services are available, they may be limited in scope, such as offering fewer types of GI (1.2 vs. 2.6, P<0.0001) and cardiac procedures (0.35 vs 1.9, P<0.0001).
Conclusions: In contrast with the hotel industry, patients who seek elite care and narrow their search to 5-star patient experience hospitals might be surprised that many types of expected care (e.g. ED, cardiology, ICU services) might not be available to them. The fact that it is difficult for them to achieve top star ratings suggests significant flaws in the utility of this system for patients.