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95% CI, 10.7%-10.7%),and 1-star hospitals with a rate of 11.2% (95% CI, 11.2%-11.3%)(P <.001 for trend).Higher CMS star ratings were also associated with lower adjusted readmission rates, with 5-star hospitals having the lowest readmissions rate of 18.7% (95% CI, 18.6%-18.8%),followed by 4-star hospitals with a rate of 20.2 (95% CI, 20.2%-20.2%),3-star hospitals with a rate of 21.0% (95% CI, 21.0%-21.0%),2-star hospitals with a rate of 21.8% (95% CI, 21.7%-21.8%),and 1-star hospitals with a rate of 22.9% (95% CI, 22.8%-22.9%)(P <.001 for trend) (Table 2).Discussion | We found that a higher CMS star rating was associated with lower patient mortality and readmissions.It is reassuring that patients can use the star ratings in guiding their health care seeking decisions given that hospitals with more stars not only offer a better experience of care, but also have lower mortality and readmissions.Our study has limitations.First, our analyses focused on the Medicare population; therefore, whether these findings would hold for younger patients is unclear.Second, although we adjusted for both patient and hospital characteristics, it is possible that some of the worse outcomes at low stars hospitals may represent residual confounding.Finally, the differences were most apparent at the extremes, with 2-to 4-star hospitals being relatively comparable.Whether this reflects the clustering methodology of the star rating program or whether quality of care is similar in these hospitals is unclear.These findings should be encouraging for policymakers and consumers; choosing 5-star hospitals does not seem to lead to worse outcomes and in fact may be driving patients to better institutions.
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