CMS Hospital Compare System of Star Ratings and Surgical Outcomes Among Patients Undergoing Surgery for Cancer: Do the Ratings Matter?

  • Rittal Mehta
  • Anghela Z. Paredes
  • Diamantis I. Tsilimigras
  • Ayesha Farooq
  • Kota Sahara
  • Katiuscha Merath
  • J. Madison Hyer
  • Susan White
  • Aslam Ejaz
  • Allan Tsung
  • Mary Dillhoff
  • Jordan M. Cloyd
  • Timothy M. PawlikEmail author
Health Services Research and Global Oncology



The Centers for Medicare and Medicaid Services (CMS) Hospital Compare star rating system has been proposed as a means to assess hospital quality performance. The current study aimed to investigate outcomes and payments among patients undergoing surgery for colorectal, lung, esophageal, pancreatic, and liver cancer across hospital star rating groups.


The Medicare Standard Analytic Files (SAF) from 2013 to 2015 were used to derive the analytic cohort. The association of star ratings to perioperative outcomes and expenditures was examined.


Among 119,854 patients, the majority underwent surgery at a 3-star (n = 34,901, 29.1%) or 4-star (n = 30,492, 25.4%) hospital. Only 12.2% (n = 14,732) were treated at a 5-star hospital. Across all procedures examined, patients who underwent surgery at a 1-star hospital had greater odds of death within 90 days than patients who had surgery at a 5-star hospital (colorectal, 1.41 [95% confidence interval {CI}, 1.25–1.60]; lung, 1.97 [95% CI 1.56–2.48]; esophagectomy, 1.83 [95% CI 0.81–4.16]; pancreatectomy, 1.70 [95% CI 1.20–2.41]; hepatectomy, 1.63 [95% CI 0.96–2.77]). A similar trend was noted for failure to rescue (FTR), with the greatest odds of FTR associated with 1-star hospitals. The median expenditure associated with an abdominal operation was $1661 more at a 1-star hospital than at a 5-star hospital (1-star: $17,399 vs 5-star: $15,738). A similar trend was noted for thoracic operations.


The risk of FTR, 90-day mortality, and increased hospital expenditure were all higher at a 1-star hospital. Further research is needed to investigate barriers to care at 5-star-rated hospitals and to target specific interventions to improve outcomes at 1-star hospitals.



There are no conflicts of interest.

Supplementary material

10434_2019_8088_MOESM1_ESM.docx (34 kb)
Supplementary material 1 (DOCX 34 kb)
10434_2019_8088_MOESM2_ESM.tiff (546 kb)
Scatter plot depicting outcomes for patients undergoing abdominal surgery stratified by star rating. (TIFF 546 kb)
10434_2019_8088_MOESM3_ESM.tiff (386 kb)
Scatter plot depicting outcomes for patients undergoing thoracic surgery stratified by star rating. (TIFF 386 kb)


  1. 1.
    Centers for Medicare and Medicaid Services. Hospital Compare. Retrieved 20 May 2019 at
  2. 2.
    Jha AK, Li Z, Orav EJ, Epstein AM. Care in U.S. hospitals: the Hospital Quality Alliance program. N Engl J Med. 2005;353:265–74.CrossRefGoogle Scholar
  3. 3.
    Frist WH. Connected health and the rise of the patient-consumer. Health Aff Millwood. 2014;33:191–3.CrossRefGoogle Scholar
  4. 4.
    Conway P. CMS Continues Progress toward a Safer Health Care System Through Integrated Efforts to Improve Patient Safety and Reduce Hospital Readmissions. Retrieved 20 May 2019 at
  5. 5.
    Yamada K, Tsukamoto S, Ochiai H, Shida D, Kanemitsu Y. Improving selection for resection of synchronous para-aortic lymph node metastases in colorectal cancer. Digest Surg. 2018;36:369–75.CrossRefGoogle Scholar
  6. 6.
    Chatterjee P, Joynt Maddox K. Patterns of performance and improvement in U.S. Medicare’s Hospital Star Ratings, 2016–2017. BMJ Qual Saf. 2018;28:486–94.CrossRefGoogle Scholar
  7. 7.
    Wallace S, Hanson KT, Dowdy SC, Habermann EB. Impact of surgical approach and patient factors on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scoring in gynecologic surgery. Gynecol Oncol. 2018;148:28–35.CrossRefGoogle Scholar
  8. 8.
    Creager MA, Kaufman JA, Conte MS. Clinical practice: acute limb ischemia. N Engl J Med. 2012;366:2198–206.CrossRefGoogle Scholar
  9. 9. Hospital Compare overall hospital rating. Retrieved 25 November 2019 at
  10. 10.
    Iezzoni LI, Daley J, Heeren T, et al. Identifying complications of care using administrative data. Med Care. 1994;32:700–15.CrossRefGoogle Scholar
  11. 11.
    Lawthers AG, McCarthy EP, Davis RB, Peterson LE, Palmer RH, Iezzoni LI. Identification of in-hospital complications from claims data: is it valid? Med Care. 2000;38:785–95.CrossRefGoogle Scholar
  12. 12.
    Weingart SN, Iezzoni LI, Davis RB, et al. Use of administrative data to find substandard care: validation of the complications screening program. Med Care. 2000;38:796–806.CrossRefGoogle Scholar
  13. 13.
    Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in Medicare patients. Ann Surg. 2009;250:1029–34.CrossRefGoogle Scholar
  14. 14.
    Hussey PS, Huckfeldt P, Hirshman S, Mehrotra A. Hospital and regional variation in Medicare payment for inpatient episodes of care. JAMA Intern Med. 2015;175:1056–7.CrossRefGoogle Scholar
  15. 15.
    Ueno H, Mochizuki H, Hashiguchi Y, et al. Potential prognostic benefit of lateral pelvic node dissection for rectal cancer located below the peritoneal reflection. Ann Surg. 2007;245:80–7.CrossRefGoogle Scholar
  16. 16.
    Reyna VF, Nelson WL, Han PK, Pignone MP. Decision making and cancer. Am Psychol. 2015;70:105–18.CrossRefGoogle Scholar
  17. 17.
    Chen J, Rathore SS, Radford MJ, Krumholz HM. JCAHO accreditation and quality of care for acute myocardial infarction. Health Aff Millwood. 2003;22:243–54.CrossRefGoogle Scholar
  18. 18.
    Knutson AC, McNamara EJ, McKellar DP, Kaufman CS, Winchester DP. The role of the American College of Surgeons’ cancer program accreditation in influencing oncologic outcomes. J Surg Oncol. 2014;110:611–5.CrossRefGoogle Scholar
  19. 19.
    Schmaltz SP, Williams SC, Chassin MR, Loeb JM, Wachter RM. Hospital performance trends on national quality measures and the association with Joint Commission accreditation. J Hosp Med. 2011;6:454–61.CrossRefGoogle Scholar
  20. 20.
    Goodrich K. Helping Consumers Make Care Choices through Hospital Compare. 2016. Retrieved 20 May 2019 at
  21. 21.
    Almazeedi S, Alhaddad E, Al-Khithr T, Alhunaidi M. Incidental gastric accessory spleen during laparoscopic sleeve gastrectomy. Int J Surg Case Rep. 2017;36:119–21.CrossRefGoogle Scholar
  22. 22.
    Kaye DR, Norton EC, Ellimoottil C, et al. Understanding the relationship between the Centers for Medicare and Medicaid Services’ Hospital Compare star rating, surgical case volume, and short-term outcomes after major cancer surgery. Cancer. 2017;123:4259–67.CrossRefGoogle Scholar
  23. 23.
    Wang DE, Tsugawa Y, Figueroa JF, Jha AK. Association between the Centers for Medicare and Medicaid Services Hospital Star Rating and Patient OutcomesAssociation Between CMS Hospital Star Rating and Patient OutcomesLetters. JAMA Intern Med. 2016;176:848–50.CrossRefGoogle Scholar
  24. 24.
    Koh CY, Inaba CS, Sujatha-Bhaskar S, Nguyen NT. Association of Centers for Medicare & Medicaid Services Overall Hospital Quality Star Rating With Outcomes in Advanced Laparoscopic Abdominal Surgery. JAMA Surg. 2017;152:1113–.Google Scholar
  25. 25.
    Johansen NJ, Saunders CM. Value-based care in the worldwide battle against cancer. Cureus. 2017;9:e1039.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Strazzabosco M, Allen JI, Teisberg EO. Value-based care in hepatology. Hepatology. 2017;65:1749–55.CrossRefGoogle Scholar
  27. 27.
    Schnipper LE, Davidson NE, Wollins DS, et al. American Society of Clinical Oncology Statement: a conceptual framework to assess the value of cancer treatment options. J Clin Oncol. 2015;33:2563–77.CrossRefGoogle Scholar
  28. 28.
    Levit L, Balogh E, Nass S, Ganz PA. Institute of Medicine. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington, DC: The National Academies Press; 2013. Scholar
  29. 29.
    Trzeciak S, Gaughan JP, Bosire J, Angelo M, Holzberg AS, Mazzarelli AJ. Association between medicare star ratings for patient experience and Medicare spending per beneficiary for U.S. hospitals. J Patient Exp. 2017;4:17–21.CrossRefGoogle Scholar
  30. 30.
    Diaz A, Schoenbrunner A, Pawlik TM. Trends in the geospatial distribution of inpatient adult surgical services across the United States. Ann Surg. 2019. Scholar
  31. 31.
    Khubchandani JA, Shen C, Ayturk D, Kiefe CI, Santry HP. Disparities in access to emergency general surgery care in the United States. Surgery. 2018;163:243–50.CrossRefGoogle Scholar
  32. 32.
    Figueroa J, Feyman Y, Blumenthal D, Jha A. Do the stars align? Distribution of high-quality ratings of healthcare sectors across U.S. markets. BMJ Qual Saf. 2018;27:287–92.CrossRefGoogle Scholar
  33. 33.
    Chen LM, Ryan AM, Shih T, Thumma JR, Dimick JB. Medicare’s acute care episode demonstration: effects of bundled payments on costs and quality of surgical care. Health Serv Res. 2018;53:632–48.CrossRefGoogle Scholar
  34. 34.
    Mues KE, Liede A, Liu J, et al. Use of the Medicare database in epidemiologic and health services research: a valuable source of real-world evidence on the older and disabled populations in the U.S. Clin Epidemiol. 2017;9:267–77.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Rittal Mehta
    • 1
  • Anghela Z. Paredes
    • 1
  • Diamantis I. Tsilimigras
    • 1
  • Ayesha Farooq
    • 1
  • Kota Sahara
    • 1
  • Katiuscha Merath
    • 1
  • J. Madison Hyer
    • 1
  • Susan White
    • 1
  • Aslam Ejaz
    • 1
  • Allan Tsung
    • 1
  • Mary Dillhoff
    • 1
  • Jordan M. Cloyd
    • 1
  • Timothy M. Pawlik
    • 1
    Email author
  1. 1.Department of Surgery, Division of Surgical OncologyThe Ohio State University Wexner Medical CenterColumbusUSA

Personalised recommendations