Edward Norton

Edward Norton, Ph.D., is a health economist working with MVC

Have you ever wondered whether the Hospital Compare star ratings really mean anything? In particular, do more stars indicate higher quality of care?  One study finds that star ratings can be important for cancer patients.

Both the Centers for Medicare and Medicaid Services’ (CMS) Hospital Compare star rating and surgical case volume have been publicized as metrics that can help patients identify high-quality hospitals for complex care such as cancer surgery. A recent study by Deborah Kaye and colleagues (2017 Cancer) evaluates the relationship between the CMS’ star rating, surgical volume, and short-term outcomes after major cancer surgery.

Their study identified 365,752 patients who underwent major cancer surgery for 1 of 9 cancer types at 2,550 hospitals. Although we generally think that higher volume hospitals have higher quality, the authors found that star rating was not associated with surgical volume (P<.001).

However, both the star rating and surgical volume were correlated with 4 short-term cancer surgery outcomes (mortality, complication rate, readmissions, and prolonged length of stay). The adjusted predicted probabilities for 5- and 1-star hospitals were 2.3% and 4.5% for mortality, 39% and 48% for complications, 10% and 15% for readmissions, and 8% and 16% for a prolonged length of stay, respectively. The adjusted predicted probabilities for hospitals with the highest and lowest quintile cancer surgery volumes were 2.7% and 5.8% for mortality, 41% and 55% for complications, 12.2% and 11.6% for readmissions, and 9.4% and 13% for a prolonged length of stay, respectively.

Furthermore, surgical volume and the star rating were similarly associated with mortality and complications, whereas the star rating was more highly associated with readmissions and prolonged length of stay.

In the absence of other information, these findings suggest that the star rating may be useful to patients when they are selecting a hospital for major cancer surgery. However, more research is needed before these ratings can supplant surgical volume as a measure of surgical quality.