Listen now (21 mins) | Listen Now Though comparatively late to adopt quality ratings, many health care products and services are today quality rated. For example, CMS rates hospital, nursing home and home health care care quality along with Medicare Advantage insurance and prescription drug, or Part D plans. Quality performance is a factor in calculating rewards and penalties in Medicare pay for performance agreements, for example, in scoring earned shared savings for Accountable Care Organizations. Though today common, rating care quality is not without criticism. For example, researchers question the validity of how component or domain scores are weighted or clustered, the absence or inadequacy of risk adjustment, meaningfulness to patients, patient literacy/numeracy limitations and unintended negative consequences.