The Centers for Medicare & Medicaid Services (CMS)’s new hospital ratings are out and by the looks of things, there won’t be much dancing in the streets.
The average overall rating was 3.1 stars, but on the wrong end of the survey were 276 hospitals that received one star – 29 more than last year. On the good end of the survey, there were 381 hospitals that received a five-star rating from CMS. But, again, the number of those five-star facilities was down significantly -- by 23% (102) -- from the last rating period.
U.S. hospitals receive star ratings based on 46 quality measures, divided into five quality categories:
Safety of care – such as the rate of complications for hip/knee replacement patients
Mortality – including the death rate for heart attack patients
Patient experience – for example, patients who reported they received help as soon as they wanted
Readmission rates – like those who were readmitted after hip/knee surgery
Timely and effective care – includes the percentage of patients who left the emergency department before being seen
It should be noted that data reflecting the COVID-19 pandemic was included in this year's ratings.
The big picture
If you look at the big picture, the CMS hospital ratings are kind of a mixed bag. Almost 10% of hospitals got the lowest score, while only 13% got the highest. But here's the thing: it's either really good or really bad. Combine the worst-rated and second-worst hospitals, and you get over 30% of the total. On the flip side, the top two ratings make up 40% of hospitals.
If you ever find yourself needing a hospital, a trip to Utah seems like your best bet. It has the highest average rating in the country.
South Dakota isn't too shabby either. In fact, only six states have an average rating of 4 stars or better. In addition to Utah and South Dakota, there’s Colorado, Minnesota, Pennsylvania, and Wisconsin.
And if you’re picky about what kind of hospital you go to, VA hospitals come out on top, followed by Critical Access Hospitals and then Acute Care Hospitals.
The data doesn't lie. Just take a look..
A symptom of a deeper issue?
To the 30-plus million people who are admitted to a hospital every year, the CMS ratings have to ring loudly. Particularly seniors, who make up the largest share of those admissions.
Kirat Kharode, a senior hospital system executive in New Jersey and Pennsylvania for twenty years before becoming the founder and CEO of HealCo and Pinewood Family Care Co., told ConsumerAffairs that these scores are a symptom of a deeper issue within the healthcare system.
“Many hospitals are struggling with bureaucratic inefficiencies, fee-for-service business models, and bloated executive salaries," he said. "The focus has often been on volume—seeing as many patients as possible and maximizing billable services—rather than on the quality of care provided.
“Consumers need to understand that these ratings reflect not just the clinical quality but also the patient experience, safety protocols, and operational efficiency. The lowering of hospital ratings by CMS isn’t just a grading issue; it highlights systemic problems, including poor communication with patients, inadequate staffing, and a lack of accountability in delivering consistent, high-quality care.”
Akin Demehin, senior director of quality and patient safety for the American Hospital Association (AHA), argues that since the CMS' star ratings represent only available measures, their relevance to a particular patient's needs may vary.
Relevance may vary
“That is why the AHA continues to encourage patients to complement information from star ratings and other hospital rankings with discussions with clinicians who know their care needs to help make fully informed decision about their care," Demehin said. "Lastly, while AHA appreciates CMS’s work in recent years to make the ratings more transparent and easier to interpret, we have continued to encourage CMS to make improvements to the methodology to ensure hospital performance is portrayed accurately and fairly."
Demehin encourages healthcare consumers to balance their decision making. Rather than take a hospital’s overall rating as the complete picture, he recommends that anyone considering a hospital stay use the CMS’ comparison site.
That way, you get the addition of an overall patient rating which measures patients' experiences of their hospital care – like how well nurses and doctors communicated, how responsive hospital staff were to their needs, and the cleanliness and quietness of the hospital environment.