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Why Did New York State Hospitals Rank So Poorly?

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New York State (NYS) hospitals perform poorly on Centers for Medicare and Medicaid Services (CMS) star ratings compared to US hospitals, particularly in patient satisfaction and readmissions. Socioeconomic factors in hospital markets contribute to these disparities.

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Area of Science:

  • Healthcare Quality
  • Hospital Performance Metrics
  • Public Health Policy

Background:

  • New York State (NYS) hospitals exhibit significantly lower performance in Centers for Medicare and Medicaid Services (CMS) star ratings compared to national averages.
  • 33% of NYS hospitals received a 1-star rating, contrasting with only 5% nationwide.

Purpose of the Study:

  • To compare the performance of NYS hospitals against all US hospitals using CMS Hospital Value-Based Purchasing (HVBP) and star ratings.
  • To identify and adjust for hospital and market characteristics contributing to NYS's observed poor performance.

Main Methods:

  • A cross-sectional observational study utilizing the CMS Hospital Care Compare database for 2019 HVBP scores.
  • Analysis of variance (ANOVA) was employed for comparative analysis, with multivariable risk adjustment for hospital (occupancy, size), fiscal (operating margin), and market (socioeconomic) characteristics.

Main Results:

  • NYS hospitals demonstrated lower patient satisfaction and higher readmission rates, significantly associated with lower socioeconomic status in their markets.
  • Risk adjustment partially mitigated these differences, but NYS hospitals still underperformed in pressure ulcer and deep vein thrombosis/pulmonary embolism prevention.
  • Performance in mortality and hospital-acquired infections was comparable between NYS and US hospitals.

Conclusions:

  • Demographic and socioeconomic factors within hospital market areas partially explain the underperformance of NYS hospitals.
  • Certain performance aspects, like extended length of stay, may reflect broader regional healthcare trends.