Unfortunately, not all healthcare providers are created equal. Having a poor experience with a physician or other medical professional can be frustrating and mentally draining, but it can have a negative impact on your health and wellness.

The Internet provides patients with the ability to leave reviews about their experiences with healthcare providers, and these reviews can sometimes be good tools to use when looking for a quality healthcare partner. What’s important to remember is that online reviews can’t always be trusted. People tend to leave reviews about negative experiences far more often than positive ones, potentially skewing results and not providing the full picture. People have different expectations regarding the level of quality in services they receive, so one person’s bad experience may not necessarily mean that someone else would be dissatisfied.

In an attempt to overcome these obstacles while still offering the public access to quality reviews, Medicare offers a star rating system. This system is administered by the Centers for Medicare & Medicaid Services (CMS), and it provides Medicare recipients with unbiased ratings on healthcare providers within the Medicare network.

What are CMS Star Ratings and What Criteria is Used?
The star rating system assigns each healthcare provider and/or facility a level of quality that uses one star to represent the lowest level of quality and five stars to represent the highest level of quality. The criteria used to measure quality include things like patient experience, but the ratings are also based on performance when measured against time. This means that things like readmission rates at hospitals, timeliness of care, and efficient use of medical imaging are all contributing factors to the facility’s overall star rating.

Ratings Are Divided Into Sections for Greater Detail
Medicare also breaks its star ratings down into sub-categories outside of general performance. These sections include health inspection results, staffing levels and quality measures that encompass 15 other metrics. These additional ratings criteria help to shape the overall picture of quality and give peace of mind to Medicare recipients who are seeking the best quality of care for their needs. This also means that it would be a good idea to look at each individual category as well as the healthcare provider’s total rating. In some cases, one or two criteria could be lacking and pull down a provider’s score, but as a whole, the provider will meet or exceed your needs in the categories that are most important to you.

Does a Lesser Rating Really Mean a Bad Experience?
One thing that needs to be understood about the Centers for Medicare & Medicaid Services rating system is that a lower rating does not mean that you will not receive quality care. Instead, a lower rating simply means that there may be better options available. All healthcare providers in the United States are held to the same standards of care, so any licensed provider will have to at least meet the minimum. Higher star ratings mean that a provider has either gone above and beyond the standard or that patient satisfaction is far greater for that provider compared to others.

To learn more about the star rating system or to inquire about a specific provider’s rating, visit CMS.gov.

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