Why Did New York State Hospitals Rank So Poorly?

Abstract

Background: According to the Centers for Medicare and Medicaid Services star ratings, New York State (NYS) hospitals are relatively poor performers, with 33% achieving 1 star compared with 5% of hospitals across the United States. Objectives: We compared NYS hospitals to all United States hospitals using Centers for Medicare and Medicaid Services Hospital Value-Based Purchasing (HVBP) and star ratings component measures. We perform risk adjustment for hospital and market characteristics associated poor performance. Research Design: This was a cross-sectional observational study. Subjects: All acute care hospitals in the United States which had HVBP scores for 2019 in April 21, 2021, Hospital Care Compare database. Measures: Analysis of variance was used to compare NYS hospitals to all United States hospitals. Multivariable-based risk adjustment was applied to NYS hospitals with adjustment for hospital characteristics (eg, occupancy, size), hospital fiscal ratios (eg, operating margin), and market characteristics (eg, percent of hospital market that has a high school diploma). Results: NYS hospitals averaged lower patient satisfaction and higher readmissions. These domains were statistically significantly associated with lower socioeconomic status in the hospital market area. Risk adjustment reduced but did not eliminate these differences. NYS also performed poorly on pressure ulcers and deep vein thrombosis/pulmonary embolism prevention. NYS hospitals were similar to the United States in mortality and hospital-acquired infections. Conclusions: Differences in the demographic makeup of hospital markets account for some of the poor performance of NYS hospitals. Some aspects, such as long length of stay, may be associated with wider regional trends.