Medicare's Star Rating System for Private Plans Is QuestionedMay 20, 2012, 9:30 a.m. PDTAs the federal government pumps billions of bonus dollars into private Medicare health plans to encourage better care, the quality rating system used to award the bonuses is coming under increasing fire.
Critics, including the Government Accountability Office and the Medicare Payment Advisory Commission, question whether the $8 billion-plus program is mostly rewarding mediocre patient quality.
The latest attack came in a
report last week from the American Action Forum, a conservative think tank, which argued that some standards are difficult to measure and that it's hard to score well when plans don't always know the criteria in advance.
Supporters defend the program as part of a broad initiative to boost the quality of patient care and point to demonstrable improvements — for instance, a San Diego physicians group that discovered 700 Medicare patients with diabetes who were not getting annual eye exams, even though failure to get early treatment can result in blindness.
"Change a compensation system, and priorities shift," said Dan Mendelson, chief executive of Avalere Health, a consulting firm. "You can see the numbers going up."
The federal government created the star rating system in 2007 as a guide to help seniors compare the quality of private health plans in the Medicare Advantage program.
