Determining the value proposition of surgical care in CMS star rated hospitals

Am J Surg. 2023 Mar;225(3):541-544. doi: 10.1016/j.amjsurg.2022.11.022. Epub 2022 Nov 18.


Background: CMS Hospital Quality Star ratings reflect the quality of care given to patients. It is hypothesized that increased Star-rating is associated with higher cost and that the value proposition is diminished.

Methods: This study used the Florida AHCA inpatient dataset, CY2019. Partial colectomy was selected as a representative inpatient surgical procedure. Analysis was performed on this data to compare high and low Star-rated hospitals.

Results: Total costs were equivalent among all Star levels on initial analysis. In a propensity matched comparison with 1 Star, 5 Star hospitals had significantly lower length-of-stay and ICU, anesthesia, radiology and lab costs, and conversely, had higher total (+2%), operating room and med-surg supply costs.

Conclusions: These results demonstrate that total colectomy costs are functionally equivalent among the CMS 1- and 5- Star categories. The results indicate that higher CMS Star ratings fulfill the value proposition and indeed offer higher quality without significantly increased cost.

Keywords: CMS Star rating; Cost centers; Outcomes; Quality; Value.

MeSH terms

  • Centers for Medicare and Medicaid Services, U.S.
  • Florida
  • Hospitals*
  • Humans
  • Inpatients*
  • Operating Rooms
  • United States