Low performance in external quality ranking programs can have a long-lasting impact on a hospital’s reputation, patient throughput, physician recruitment, and payor negotiations. Many healthcare delivery organizations struggle with low ratings from CMS, Leapfrog, and U.S. News because the measurement systems differ. Improving quality scores hinges on developing a strategy to accurately represent the quality of care to each individual ranking system, and, perhaps most importantly, partnering with experts who understand the nuances of quality program scoring.
Your External Quality Rankings Matter
External quality rankings are no longer just symbolic. Patients and families use quality scores to make decisions about where to seek care and increasingly, so do payers, employers, medical students, and even physician groups. Research shows patients are willing to pay more and travel further for a hospital with higher quality rankings.
From an external perspective, rankings like the CMS Star Ratings, Leapfrog Grades, and U.S News Rankings are powerful external signals of performance. Yet, many hospital executives feel their scores do not reflect the quality of care delivered at the bedside.
This disconnect is rarely due to poor clinical performance but more often the result of incomplete documentation, underrepresented patient risk factors, or gaps in coding operations. These are solvable challenges that require a deliberate, organization-wide approach focused on data integrity and provider engagement.
Five Steps to Improving Your Hospital Quality Scores
Improving quality scores is not just about achieving great clinical outcomes. It also requires a focused strategy to ensure the complexity and severity of your patient population is accurately reflected. By creating an accurate picture of acuity and delivering excellent quality outcomes, your clinicians can dedicate 100% of their focus to delivering high-quality care in every patient setting.
1. Document What Matters Most
External quality programs rely on quality-specific inputs that differ from traditional revenue-focused Clinical Documentation Integrity programs. Risk-adjusted measures such as mortality, readmissions, and safety complications depend heavily on documentation of comorbidities and chronic conditions.
For example, if obesity, malnutrition, or renal failure codes are not clinically documented and billed to Medicare, your risk adjustment models will understate the complexity of your patient population and skew performance, even if outcomes are favorable. Clinical documentation teams must balance reimbursement goals and accurate risk adjustment capture that align with quality program specifications.
2. Be Proactive, Not Reactive
Too often, hospitals are surprised by a decrease in CMS Stars or a downgraded Leapfrog Safety Grade. By the time the score is released, it’s too late to course correct for the current year.
High-performing organizations are now using predictive modeling to forecast future scores and identify lagging quality metrics. With the right analytics, you can model how today’s documentation, infection rates, and readmissions trends will affect next year’s ratings and act accordingly.
Client Partner Example: Impact Advisors developed a custom CMS Star Rating forecasting model that enabled a major health system to anticipate a potential drop in their CMS Star Rating >13 months before the official scores were released.
3. Maximize Your EHR and Embrace Automation
Automating risk-adjusting diagnoses capture at the point of care reduces manual burden for providers and improves accuracy.
Impact Advisors Solution Examples:
- Real-time alerts within patient account notes that suggest updates to the Problem List based on lab results, medication orders, or consult notes. The suggestions are based on clinical evidence provided by other clinicians throughout the patient’s stay. Providers can quickly reference past documentation and make a clinical determination about whether the condition remains relevant.
- Quality indicators flag potential diagnosis codes for Patient Safety Indicators (PSIs) or Hospital-Acquired Conditions (HACs), such as pressure ulcers or hospital-associated trauma, when the coder prepares to finalize the claim. At that point, coding can hold the claim for secondary clinical review to ensure documentation accuracy and clinical validation.
- Automated population of risk factors into Discharge Summaries or consult notes. The goal is to make it as easy as possible for clinicians to capture risk factors during the hospital stay and help the organization avoid unnecessary penalties.
4. Engage and Educate Your Clinicians
Providers are at the front line of quality documentation. However, many physicians are unaware that omitting a diagnosis, like dementia or depression, when they are clinically relevant, may distort publicly reported mortality and readmission rates.
To engage providers, education must go beyond basic compliance. Bringing together CDI, quality leaders, and clinical champions to co-develop brief, targeted education helps connect documentation to clinical reputation and organization performance. When clinicians understand the “why,” they’re more likely to change the “how.”
5. Parner with Experts Who Know the Landscape
Navigating external quality programs is complex and internal resources are often stretched thin.
An experienced partner can:
- Perform root cause analysis on historical score declines.
- Identify documentation blind spots affecting risk adjustment.
- Implement proven solutions to improve capture of conditions that matter most for quality scoring.
The right partner brings subject matter expertise, proven tools, and a tailored roadmap, and most importantly, can help you prioritize what will have the greatest impact.
Client Partner Example: After partnering with Impact Advisors, a large academic medical center improved documentation accuracy and gained visibility into CMS Star performance, positioning them to move from 1 to 3 Stars in the next reporting period.
The Bottom Line
In today’s competitive market environment, quality rankings matter. The impact of quality rankings can affect your bottom line, your brand, and your ability to deliver on your organization’s goals.
If your organization is uncertain about where to start or frustrated that performance doesn’t match perception, it’s time to realign your strategy. Begin with documentation. Leverage predictive insights. Engage your clinical workforce. And find a trusted partner to guide the way.
About Impact Advisors
Impact Advisors can help identify and prioritize solutions that directly impact your external quality scores. Our holistic approach automates data capture, focuses on documentation that matters, and utilizes predictive analytics to forecast quality rankings, enabling you to improve your quality rankings, grades, and scores in the shortest amount of time.
References:
Logan Trenaman, Mark Harrison, Jeffrey S. Hoch, What is a star worth to Medicare beneficiaries, Health Affairs Scholar, Volume 2, Issue 1, January 2024
