Medicare Hospital Star Ratings Show Challenges for Quad Cities Providers

Medicare employs a star rating system to evaluate hospital performance on various metrics, including sepsis care and emergency room (ER) wait times. Recent ratings for hospitals in the Quad Cities area show MercyOne Genesis in Davenport receiving a 1-star rating, with only 54% of patients receiving appropriate sepsis care and 6% leaving the ER before being seen, a rate triple the national average. UnityPoint Health – Trinity Rock Island earned a 2-star rating, with sepsis care provided to less than half of the patients and an 8% ER leave rate before treatment. Both hospitals have noted that the data, collected from 2020 to 2023, might not accurately represent current patient experiences and have initiatives underway to improve care quality and reduce ER wait times. The Medicare star ratings have faced scrutiny from healthcare providers and organizations like the American Hospital Association (AHA), which has called for refinements to CMS’s methodology to ensure fair and accurate hospital performance representation. Factors that can influence rating fluctuations include changes in measurement criteria, evaluation periods, and coding practices. Hospital officials stress the importance of using star ratings as one of multiple tools for assessing hospital quality, encouraging patients to seek clinician consultations for informed decisions. The ratings stand amid a backdrop of increasing ER visits nationwide, with the CDC reporting a record 155 million visits in 2022. Hospitals such as MercyOne Genesis emphasize their role as regional referral centers handling complex cases, which may impact performance metrics. Both MercyOne and UnityPoint have committed to ongoing quality improvement efforts, including safety training and clinical initiatives targeting enhanced sepsis care and shorter ER wait times. This analysis points to the continued challenges hospitals face in balancing high patient volumes and complex care demands with regulatory expectations and quality outcomes. It also highlights the evolving nature of healthcare quality metrics and the need for nuanced interpretation by insurance professionals, providers, and policymakers. Medicare's use of star ratings remains a significant but debated tool for informing healthcare decisions and policy, particularly as hospitals seek to align operational realities with regulatory standards.