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Updated hospital quality ratings released by the federal government last month despite backlash from hospital advocates allow patients to compare health systems based on certain quality metrics, including mortality, safety, efficiency and patient experience.

The federal government's Hospital Compare website updated its measurement data and facility "star rating," which assigns hospitals a rating between one and five stars, with five stars being best. In Chattanooga, CHI Memorial Hospital received four stars, Parkridge Medical Center received three stars and Erlanger Medical Center received two stars.

Hospital Compare is part of the government's effort to increase value and lower health care costs by reporting on hospitals' quality of care. Although many hospital leaders say the data helps health systems improve and brings needed transparency to the industry, they also say the ratings are flawed and unfairly punish hospitals that perform more complex procedures and treat higher volumes of sick patients.

Star ratings for hospitals within 50 miles of Chattanooga:

ERLANGER MEDICAL CENTER: 2 out of 5 stars

MEMORIAL HEALTHCARE SYSTEM: 4 out of 5 stars

PARKRIDGE MEDICAL CENTER: 3 out of 5 stars

CHI MEMORIAL HOSPITAL- GEORGIA: (too small to measure)

HAMILTON MEDICAL CENTER: 4 out of 5 stars

TENNOVA HEALTHCARE-CLEVELAND: 2 out of 5 stars

ADVENTHEALTH MURRAY: 4 out of 5 stars

RHEA MEDICAL CENTER: 2 out of 5 stars

Get more information behind the star ratings by visiting the Hospital Compare website: https://www.medicare.gov/hospitalcompare.

Source: U.S. Centers for Medicare and Medicaid Services

"There continues to be an evolving methodology and certain biases in the data. People may use only Hospital Compare rankings in making their health care decisions without considering that Erlanger treats, on average, more patients with [more serious conditions], which could lead to lower rankings," Mike Bettinger, Erlanger senior director of quality analytics, said in an email.

Melissa Roden, vice president of quality at CHI Memorial and CommonSpirit Health Southeast division, said other issues include a lag in the data — with the most recent data used coming from December 2018 — and inconsistencies across different hospital ranking agencies, such as Leapfrog and U.S. News and World Report.

"There are many different ratings, which can be confusing for consumers and hospitals. There's a lot of hospitals with great star ratings that may not have good Leapfrog safety grades," Roden said. "We're very pleased we're a four-star rating, but our focus is on the individual metrics."

Roden said although the star ratings are somewhat controversial, digging into the metrics behind the ratings can be useful. Still, no rating system should trump a doctor's expertise.

"The data is supplemental to that patient-physician relationship. I will tell a patient that there are different sites where hospital data is reflected, but having that conversation with the physician is critical," she said.

The government also incentivizes quality by taking the data into account when paying hospitals. Hospitals receive penalties when patients acquire conditions during their stay or are readmitted within 30 days of discharge. Examples of hospital-acquired conditions include injuries, surgical site infections, catheter-associated infections or when a foreign object is left inside someone after surgery.

For 2020, Medicare payments to Parkridge will be reduced 1% due to high rates of complications and another 1.22% due to excess rehospitalizations, which have increased at Parkridge for five consecutive years. Representatives from Parkridge Health System did not return requests for comment.

Erlanger won't be penalized for complications but will be penalized slightly for excess rehospitalizations. Erlanger officials said the hospital has worked hard to improve its readmission penalty by guiding patients more through the discharge process. As a result, Erlanger's Medicare payments will be reduced by 0.04% this year compared to 0.26% last year, amounting to an approximately $1 million loss.

The U.S. Centers for Medicare and Medicaid Services announced in August its plans to propose updates to the star ratings methodology through rulemaking in 2020. One of those proposed changes would group comparable hospitals with their peers, which Bettinger said is "definitely a step in the right direction for health care systems like Erlanger."

Contact Elizabeth Fite at efite@timesfreepress.com or 423-757-6673.

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