In a previous role I often worked with various hospital/medical ‘quality’ rating systems. Is anybody other than the metric developers themselves actually happy with either the methods or the resulting ratings? Certainly clinicians never seemed to be. It seemed like if you had the time and the propensity essentially every metric could be undermined, and pretty often you’d find a peer-reviewed article doing just that either from the clinical side or the methodological side. Someday I’ll write a longer post about what I remember from working in quality and specific issues with common quality ratings. In the meantime here’s the latest on recent CMS Star method revisions.