Medicare and Medicaid Hospital Quality Ratings and Hospital Community Commitment: A Cross-Sectional Study

Centers for Medicare & Medicaid Services (CMS) Overall Hospital Quality Star Ratings provide public hospital quality metrics, yet may not fully account for community-level social risk factors affecting patient outcomes. This cross-sectional study of 2,348 US acute care hospitals investigated the association between CMS Overall Hospital Quality Star Ratings and hospital performance on measures of community commitment, defined by the Lown Institute's inclusivity and community benefit metrics.

Data came from the CMS July 2024 Hospital General Information and Lown Institute Hospital Index for Social Responsibility datasets. Lown Institute inclusivity, reflecting demographic alignment between a hospital's patient population and its surrounding community, and community benefit, reflecting selected hospital financial measures related to service to and support for vulnerable populations, were used as hospital-level proxies for community commitment.

Kendall's τb partial correlations showed that higher star ratings were weakly associated with worse hospital ranks for the Lown Institute's inclusivity (partial τ_b = 0.145, 99.9% confidence interval [CI] 0.100-0.190) and community benefit metrics (partial τ_b = 0.181, 99.9% CI 0.136-0.226). Ratings were also inversely associated with inclusivity subscores and Medicaid revenue share.

Higher CMS star ratings demonstrated weak inverse associations with hospital-level measures of community commitment related to service to and support for vulnerable communities. These findings suggest current CMS star ratings may incompletely account for the social risk profile of the populations that hospitals serve, although the modest magnitude of the associations warrants cautious interpretation. To ensure that quality ratings accurately reflect quality of care, policymakers may consider enhancing adjustment for the social risk factors present in the communities that hospitals serve.