The Fault in Our Stars

By Charlie Miraglia

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To improve the cost effectiveness and quality of service provided to its beneficiaries, the Centers for Medicare and Medicaid Services (CMS) is working with Medicare Advantage Plans through a ratings system designated as the STARS Program. The program measures the performance of the plans by examining a cross section of metrics that should ultimately help them determine the “quality” of each. Scores ranging from one to five stars are awarded in four major categories:

Determining successful activities around staying healthy is accomplished by evaluating how often members receive checkups, screening tests, vaccines and other preventative services designed to keep them healthy. It also hinges on how effectively care plans help manage long term or chronic conditions, which currently focus on diabetes and medication management. The satisfaction of its members, or how they “feel” about the quality of care received, and the responsiveness of the plan’s customer service, are obviously a bit more subjective measures.

Nevertheless, the compilation of data is necessary for any ratings system to be worthwhile, and this one is no exception. The sources of data used here include the Health Effectiveness Data and Information Set (HEDIS), pharmacy Prescription Drug Event (PDE) data, and a Health Outcomes Survey (HOS) which are all used as clinical quality standards. For member satisfaction on the other hand, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and member complaint tracking documentation are used, while the administrative performance and compliance standards are measured using CMS audits, and the integrity of Part D pharmacy data as well as call center performance.

OK, let’s take a deep breath after all that background and examine whether this approach really makes any sense, and examine the pitfalls that are sure to arise. After all, what could possibly go wrong with a government run program?


First off, if you ask officials at lower ranking hospitals what they think, they will tell you that a one to five star rating system does not adequately capture all of the complexities associated with administering care to patients with chronic conditions, especially low-income patients who often have multiple disorders. Let’s face it, this isn’t a Yelp rating of how yummy a meal was, or a Trip Advisor review trying to quantify how good the view was at the hotel – peoples lives are at stake here.

In addition, some would argue that too much weight is placed on patient reviews in the STARS Program, and that (so far at least) no measurements are in place to capture hospital acquired infections, readmission rates to the hospital, or even death from some complication of care during the hospitalization. Another point of concern is the fact that much of the data is old or outdated, so hospitals are “punished” in areas they may have already addressed, or at least taken steps to improve.

Let’s face it, we’re living in an age of consumerism from which healthcare is not immune. More and more patients are going to be evaluating physicians and hospitals when shopping for the “best” care available. While it might not be perfect (or even close), the STARS Program is one example of an attempt to collect data to help patients evaluate which providers are doing the best job and deserve their hard earned healthcare dollars. As healthcare systems “get with the program” and begin using real time data to engage patients and physicians throughout the process, the age of “personalized medicine” will be upon us.

I feel compelled to mention that I had three reasons for choosing the title for this week’s blog. The first is the obvious play on words, so enough said there. Second, the plot of this tear-filled film is clearly healthcare related, telling the story of two “star-crossed” teenage lovers who meet at a cancer support group. And finally, the author of the book on which the movie is based is from here in Indianapolis, our hometown. With all of that going for it, one could even say that the “stars were aligned” to make this the perfect title!

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