CMS Overall Quality 5 Star Rankings Leapfrog Hospital

CMS Overall Quality 5 Star Rankings Leapfrog Hospital Safety Grades US News and World Report Best Hospitals Healthgrades America's Best Hospitals Fortune/IBM Watson Health 100 Top Hospitals Lists the top 100 hospitals in Assigns the highest performing the US, segmented by type hospitals to a top 50, top 100, (teaching & community), and or top 250 cohort ranks the top 15 health systems Annually / February Scoring Type Assigns every eligible hospital 1 to 5 stars Assigns every eligible hospital a letter grade, A to F Ranks the 20 best hospitals overall and ranks hospitals for several specialties Update Frequency / Release Date Annually / April 2021 Semi-Annually / April & November Annually / July Methodology Hospitals are evaluated on up to 51 measures across 5 measure groups – mortality, safety of care, readmissions, patient experience, and timely and effective care. Hospitals receive a star rating within a peer group, which is based on meeting the thresholds for reporting measures in three, four, or five of the measure domains. Within these peer groups, hospitals may be portrayed in a positive light (4 & 5 stars) and or in a negative light (1 & 2 stars). Hospitals are evaluated on 27 measures distributed across 2 domains – process & structural measures, and outcome measures. All eligible hospitals are listed, with some portrayed in a positive light (A & B grades) and some in a negative light (D & F grades). Hospitals are evaluated on performance on 11 measures Hospitals are evaluated on distributed across 5 domains – several measures reflecting performance on 32 measures inpatient outcomes, extended performance on 10 procedures created by Healthgrades. The outcomes, and conditions and dimensions measures quantify hospital operational efficiency, financial of performance within 16 performance on dimensions of health, and patient experience. specialties. Only top hospitals mortality and complications. Community health surveys are listed. Only top hospitals are listed. sent to finalists to further refine the rankings. Only top hospitals are listed. Data Sources Publicly available data collected from the Centers for Medicare & Medicaid Services (CMS) and reported on Care Compare Publicly available data from CMS, and surveys sent by Leapfrog and completed by hospitals Publicly available data from CMS, American Hospital Association survey data, American Hospital Directory data, and surveys sent by US News and completed by physicians Publicly available data from CMS, with surveys sent to finalists Do Rankings Incorporate a Survey*? No Yes California Hospitals Receiving Top Marks 39 5 Star Hospitals 93 Awarded an “A” Grade 5 In Top 20 Honor Roll 13 In Top 50 1 in Top 100 *Incorporate a survey besides HCAHPS Annually

Revised Hospital Star Ratings: Effects on California Hospitals For its April 2021 release, CMS made several changes to its overall 5 star quality rating system. These changes include: • Replacing latent variable modeling – a flawed and widely criticized methodology – with simple averaging. • Condensing measure groups from 7 to 5. • Assigning ratings only to hospitals reporting a minimum number of measures in certain groups. • Assigning hospitals to peer groups based on the number of measure groups reported for score comparison. • Allowing critical access hospitals to withhold public reporting of star ratings. The new process CMS will use: • Candidate measures are selected and scores across hospitals are standardized. • Measures are rolled into 5 groups and assigned weights. • Group scores are calculated using a simple average of the measures in each group. • Combine measure group scores into a summary score. • Apply reporting threshold filters – only hospitals that report at least three measures in at least three measure groups (one of which must be mortality or safety) are included. • Assign hospitals to peer groups. • Calculate overall star ratings by using a statistical technique that clusters hospitals into five groups, one for each star. Hospital Preview: Hospital-specific preview reports of Overall Star Ratings were made available by CMS for hospitals until Feb. 26 on the Quality. Net website. CHA encouraged members to view their reports in advance of the public release. Distribution of California Hospitals by Star Rating The impact of the methodology change was minimally positive for California’s hospitals.