Star Rating

New Star Rating cutoffs for 2017 are out. As expected, the new cutoffs deviated from last year’s cutoffs, and will substantially affect the calculation of the overall Star Rating. Once again, many MA plans will be surprised.

In this article, we estimate the dollar impact of improving one star rating measure in the MA Star Rating system. Based on the CMS advance notice [1], if an MA plan scores 4 stars and above, the plan can receive 5% Quality Bonus Payments (QBP). Below 3.5 stars, plans…

Each year, the Centers for Medicare and Medicaid Services (CMS) collect various quality and performance measures on Medicare Advantage (MA) plans. CMS analyzes this massive collection of information and assigns from 1 star to 5 stars to each…

If you carefully read the technical notes of 2015 star rating, you will discover that the readmission rates are not the observed hospital readmission rates. The equation in Attachment F shows how the final rate is calculated.

From our previous posts, you may remember that the star rating system is quite similar to how we calculated our GPAs (the average of your letter grades). For example, you may have gotten A’s for math courses, but B’s for liberal arts courses…