Every year, the Centers for Medicare & Medicaid Services (CMS) release a series of star ratings that patients can use to evaluate the quality of the services that a Medicare Advantage health plan offers.
As a health insurance provider, it’s important to make sure your CMS star rating is in tip top condition. CMS star ratings help patients identify high-quality Medicare health plans, with a five-star rating indicating excellence. If your rating falls below this threshold, not only will patients be less likely to select your plans, but you could face penalties and fines from the CMS.
The CMS calculates its star ratings on a scale of 1 to 5 based on the following factors:
- Mortality
- Safety of care
- Readmission rates
- Patient experience
- Timely and effective care
If your CMS star ratings slip or you’re simply looking for new ways to improve your services, it might be a good idea to look into improving your language access plan. Patients with limited English proficiency (LEP) make up a significant proportion of Medicare recipients, and as such, it’s important to make sure you’re serving them effectively if you want to boost your star rating. By offering a diverse range of language access services for LEP patients, you can improve their overall experience with your organization, thereby increasing your CMS star ratings.
Although language access is not factored directly into your CMS star rankings, improving language access can help you perform better on the other measures that the CMS uses to calculate your star rankings. In this blog post, we’ll take a look at how your agency can improve its language access services and, in turn, boost your CMS star rating.
The Growing Population of LEP Patients
Nearly 10% of the United States’ population has LEP, meaning that they are unable to effectively understand or communicate in English. Research suggests that immigrants — particularly those with LEP — are more likely than their U.S.-born counterparts to be enrolled in Medicare services.
And given that the number of older individuals with LEP is projected to grow significantly over the course of the next 40 years (by 2060, experts predict the number of older LEP immigrants will grow to 22 million, up by 15 million from 2018), it’s important to make sure that you’re able to serve this population just as well as you’re able to serve English speakers.
Patients — regardless of the language that they speak — need to be able to understand their health status and communicate effectively with their healthcare providers and insurance agencies. By offering language access services that improve your organization’s transparency, outreach, and communication with consumers, you can contribute to improved health outcomes for the country’s growing population of individuals with LEP.
The Link Between Language Access and CMS Star Ratings
While the CMS won’t take your language access measures into account when developing star ratings, high-quality language access is likely to improve your performance on the measures that they do factor into their star ratings.
In recent years, CMS star ratings have been on a downward trend — more and more providers are performing worse than they have in past years. And that could be because many of them aren’t well-prepared to meet the needs of their patients with LEP.
Let’s take a look at the different factors that go into your CMS star ratings, and how improving language access can help you improve your score on each.
Mortality
The CMS looks at the mortality rates of patients enrolled in a specific plan when determining their star rankings — the lower your mortality rate, the higher your star rating will be. LEP appears to be a factor that can increase mortality rates — according to a report published in 2016, LEP “was associated with a 31% increased odds of mortality” among patients with sepsis, even after accounting for illness severity, comorbidities and other factors.
While it depends on the type of healthcare issue patients face, making sure they are well-informed about their plan and comfortable seeking out the treatment they need, you can lower the overall mortality rate of your plan. In the case of LEP patients, translating important medical information and offering interpretation services as needed will empower patients to make informed choices about their healthcare.
Safety of Care
This measure looks at the rate of serious complications patients can potentially face when seeking treatment, such as surgery site infections or catheter-induced urinary tract infections. Language access may not directly impact this measure, but you should be able to effectively communicate the level of risk patients might face. Additionally, making sure interpreters are available and present either in person or remotely can ensure patients are knowledgeable about the health procedures they’re undergoing, allowing them to make decisions accordingly.
Readmission Rates
If patients frequently have to return to the hospital after surgeries or health emergencies like heart attacks and stroke, your CMS star rating will go down. Patients with LEP have been shown to have particularly high readmission rates when compared to patients who speak English.
If you’re looking to reduce readmission rates, it’s a good idea to look into whether or not your readmission rates are higher for your LEP patients. If it is, working with a language service provider to improve your language access could be a good first step to improving this measure. In 2017, researchers found that access to interpreters had a significant impact on lowering the readmission rates for patients with LEP, from 17.8% to 13.4%.
Patient Experience
CMS star ratings also take the patient reviews into account — if patients aren’t satisfied with the care they’re receiving, it could take your rating down a notch. While it’s true that language access can be a matter of life or death in certain situations, it’s also an important way to make patients feel more comfortable, regardless of the severity of their health situation. LEP patients who have access to high-quality language access services may be more likely to report a positive patient experience, which could give your rating a well-needed boost on this measure.
Timely and Effective Care
The longer it takes to give patients effective care, the lower your star rating is likely to be here. And wait times tend to be much longer for patients with LEP than for English-speaking patients: A 2022 study found that folks with LEP spend an average of 31.9 minutes in the waiting room, while English speakers wait just 21.8.
On this measure, interpreters can play a particularly important role — if patients with LEP regularly have to wait for a long time to receive interpreting services, it could delay their access to effective care, ultimately hurting your star rating. Work with a language service provider to make sure interpreting services are available on standby so that you can get them access to an interpreter as soon as possible.
Summary
Your CMS star ratings are an important way for patients to understand the quality of care they’re receiving. In order to avoid penalties and fines, it’s important to aim for a five-star rating; considering the unique needs of LEP patients, language access is likely to play an important role in reaching that perfect score.
If you’re looking to improve your language access services and boost your CMS star ratings, Avantpage is here to help. We know how important language access is for LEP patients and are proud to provide specialized translation, interpreting, and localization services for healthcare providers. Contact us today at [email protected] or (530) 750-2040.
