Second Guessing Medicare’s Star Rating System

Kaiserhealthnews.org: By Marilyn Werber Serafini, KHN Staff Writer, MAY 20, 2012.

This story was produced in collaboration with wapo

As the federal government pumps billions of bonus dollars into private Medicare health plans to encourage better care, the quality rating system used to award the bonuses is coming under increasing fire.

Critics, including the Government Accountability Office and the Medicare Payment Advisory Commission (MedPAC), question whether the $8 billion-plus program is mostly rewarding mediocre patient care. The latest attack came in a report last week from the American Action Forum, a conservative think tank, which argued that some standards are difficult to measure, and that it’s hard to score well when plans don’t always know the criteria in advance.

Supporters defend the program as part of a broad initiative to boost the quality of patient care and point to demonstrable improvements – for instance, a San Diego physicians’ group that discovered 700 Medicare patients with diabetes who were not getting annual eye exams, even though failure to get early treatment can result in blindness.

“Change a compensation system, and priorities shift,” said Dan Mendelson, CEO of Avalere Health, a consulting and research firm. “You can see the numbers going up.” Read More