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CMS's Hospice Star Rating System Limited By Missing Data.

Amanda C Chen¹, David C Grabowski²

¹Amanda C. Chen (amandachen@g.harvard.edu), Harvard University, Cambridge, Massachusetts.

Health Affairs (Project Hope)

|June 2, 2025

Summary

This summary is machine-generated.

Most US hospices lack a star rating from the Centers for Medicare and Medicaid Services (CMS), with this trend increasing since 2022. This limited impact suggests a need for policy changes to enhance hospice star ratings for patients.

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Area of Science:

Health Services Research
Public Health Policy
Gerontology

Background:

The Centers for Medicare and Medicaid Services (CMS) implemented a hospice star rating system in 2022.
Publicly reported quality metrics aim to inform patient choice and drive quality improvement.

Purpose of the Study:

To evaluate the impact and reach of the CMS hospice star rating system.
To identify reasons for the low proportion of hospices receiving star ratings.
To propose recommendations for improving the hospice star rating system.

Main Methods:

Analysis of CMS hospice star rating data from 2022 to 2024.
Assessment of the proportion of US hospices assigned a star rating over time.
Qualitative review of potential factors influencing rating assignment.

Main Results:

Two-thirds of US hospices were initially excluded from the star rating system in 2022.
The percentage of hospices without a star rating has progressively increased through 2024.
The current system appears to have limited reach and impact on the hospice market.

Conclusions:

The CMS hospice star rating system, as currently implemented, has not achieved widespread application.
Policy adjustments are necessary to ensure the ratings provide meaningful information to patients and stakeholders.
Recommendations are provided for CMS and policymakers to enhance the value and utility of hospice star ratings.