3 Ways to Help Improve Star Ratings for Healthcare Organizations

Aug 11, 2022

Much like advancements in technology have recently revealed previously unseen stars and galaxies, there is an opportunity in healthcare to bring additional stars to light. Virtual stars, that is, like the ones used in ratings for hospitals and insurance companies.

Star ratings were put into place by the Centers for Medicare and Medicaid Services (CMS) to help consumers compare hospitals and insurance providers and make informed choices about the quality of their healthcare. These ratings follow the familiar five-star format, with five stars equating to significantly above-average quality and one star meaning quality is below average.

The hospital quality star rating from CMS takes the average of a hospital’s score across five categories (with over 100 measures in each) for the overall rating. These categories include:

Mortality
Safety of care
Readmission
Patient experience
Timely and effective care

The data for this rating system is typically collected from patients through surveys managed by third-party vendors. Healthcare organizations can also submit data points to be averaged into the score.

While the calculations are straightforward, understanding how to improve them can be more challenging. But it’s a challenge worth tackling when a higher star rating can mean better reimbursement opportunities and a stellar reputation with current and prospective patients and members.

Here are three steps to get you started:

Step #1: Create a clear path to your data.

Data that is easily accessible is data that gets used, particularly when it is needed for CMS to reimburse your facility for services rendered. If a star rating is low, it could put your organization in jeopardy of not getting reimbursed by a consumer’s healthcare insurance company or lead to even more serious issues such further auditing, fines, or being shut down. Of course, it’s also important to keep track of your patient or consumer perspective to see how they feel about the quality of care received. The combination of qualitative and quantitative data included in star ratings is crucial to get a read on consumer sentiment.

“When we talk about star ratings, something we naturally want to do is get in touch with data. We ask questions like, ‘How well are you accessing your data?’ and ‘How well is your EMR system working for you?’ You also want to take consumer experience (CX) into account. Did they feel like they got what they needed? Consumers are willing to pay for quality healthcare if they have positive experiences. Star ratings help set quality standards within large organizations like insurance companies and hospital systems.”

Tiffany Lilly, RN, BSN , Healthcare CX Consultant

Step #2: View your organization’s star rating as a standard to exceed, not just a box to check.

In the healthcare industry where competition is fierce, your star rating is a helpful tool for quality assurance. Strive to exceed your current star ratings and differentiate from your competition. If an organization puts the time in to truly improve CX, it will be seen as an effort that both internalizes and prioritizes quality for consumers and their own reputation.

Step #3: Pull in a partner that can champion your quest for better star ratings through accessible data, better analytics, and CX consulting.

Creating more interoperability between your EMR and other systems and services can be a game-changer. Negative consumer sentiment is frequently a symptom of a larger issues. Often, the number one root cause of poor CX is because the processes are not in place to support your consumers. Take a close look at those processes and see how you can create more efficiencies to get consumers what they need, when they need it.

Our Voice of Customer program helps combat the closed-loop communication that is frequently used when requesting consumer feedback. The VoC program at TTEC Digital can assist in collecting crucial information on what happened during the experience, fixing any issues, and then creating improved processes based on those responses to make it better the next time around.

“Our perspective at TTEC Digital is, ‘Let’s understand your current state and what's getting in the way. What are we not understanding, and what processes are getting in your way to servicing consumers?’ Once we understand what data we need to be monitoring, we can work to help you make sure you’re always creating exceptional consumer experiences that can be captured in star ratings.”

Tiffany Lilly, RN, BSN, Healthcare CX Consultant

However, it’s important to note that applying data and technology insights isn’t the only way to start improving star ratings. Use these in tandem with the Digital Front Door innovation from TTEC Digital to create a digitally optimized ecosystem for patients and members to access the information, support, and care they need quickly and easily. With nearly 50 years of CX expertise and cutting-edge innovations, TTEC Digital has transformed patient and member experiences for hundreds of healthcare organizations.