Between the guarded approach of CMS methodology — that is, equal weights for each domain — and the “all-in” approach in which all weights are attributed to major clinical outcomes, there are numerous ways to prioritize major clinical outcomes and, meanwhile, value process outcomes.
Here we examine one such alternative, in which the standardized mortality ratio and standardized hospitalization ratio are each attributed 25 percent weights, while the five other metrics are each attributed 10 percent weights.
The alternative methodology more closely resembles the CMS methodology, so the relationship between the ratings is unsurprisingly stronger, as 63 percent of facilities are assigned equal numbers of stars by the contrasting approaches.
Extreme swings in star ratings are not apparent, as no facilities assigned one star by the CMS methodology are assigned either four or five stars by the alternative rating. Likewise, no facilities assigned five stars by the CMS methodology are assigned either one or two stars by the alternative rating.
Deviations of one star between the contrasting approaches, however, are common. Almost 36 percent of facilities are assigned either one more or one less star by the alternative rating than by the CMS methodology, underscoring the uncertainty in ratings that can be attributed to the inherently subjective prioritization of weights for domains and constituent metrics.
Comparison of rating from CMS methodology vs. rating based exclusively on SMR & SHR
Number of facilities
(Alternative facility score in rows; CMS rating in columns)
Movement from CMS rating
(Movement in rows; CMS rating in columns)