Medicare/Medicaid/CMS Star Rating System

CMS (Center for Medicare/Medicaid Services) started a couple of years ago …what they call Star Rating System.. it can/will impact all of those providers in providing healthcare to those pts covered by Medicare/Medicaid/Medicare Advantage.

The Star Rating System will help determine how much or how little a provider gets paid and if a provider fails to attain a THREE STAR rating in at least one out of a three year period.. there ability to participate in the Federal programs.

769 Hospitals Penalized For Patient Safety In 2017: Data Table   Here is a article about 769 hospitals getting lower reimbursements in 2017 because pts filled grievances with CMS.

I have been exchanging emails with a pt that after patronizing a particular Walgreens in Florida for several years… there was a change in the Pharmacist/PIC… who decided that she was “not comfortable” with a C-II prescription – continuing of medication – for the pt.

The pt contacted Walgreens corporate and in the past … the normal response from corporate was that they “stood behind their Pharmacist’s decision”… What has changed at Walgreen’s corporate level, this pt this time was told that they would take the pt’s complaint/grievance “higher up the corporate ladder”.

Don’t know if the Star Rating system influenced this change or some other issue within Walgreen’s corporate structure…but… in regards of all healthcare providers (hospitals, prescribers, pharmacies/pharmacists, insurance company, etc… etc…) they are all covered by the Star Rating system… and apparently CMS gives a provider FIVE STARS to start off with and unless unsatisfied/unhappy pts contacts CMS ( 800-MEDICARE and file a grievance against the provider… they will retain their higher star rating…. and pt care will continue to be poor and/or get poorer because there is no consequences or incentives to improve the level of care.

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