CMS hospital ratings: 60% of hospitals earned 3 stars or less

Many hospitals have struggled to offer safe and effective care in the years since the COVID-19 pandemic turned their operations upside down.

The Centers for Medicare and Medicaid Services’ 2024 hospital star ratings, released Wednesday, showed more hospitals than last year performed poorly. That may be, in part, because the data submitted by hospitals was from April 2019 through March 2023 and excluded facilities’ performance on quality metrics from the first half of 2020.

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Last year's ratings were based on data from 2018 through the beginning of 2022. In effect then, the data determining 2024 performance reflected more of the heart of the pandemic.

Across peer groups and facility types, nearly 10% of the 2,834 hospitals CMS rated received one star, 21% got two stars, 29% got three stars, 27% earned four stars and 13% got five stars.

CMS’ star ratings, released annually, are used by patients and hospitals to better understand facilities’ performances on various quality measures and compare outcomes between facilities.

Here is what to know about the ratings.

1. More hospitals got just one star

The number of hospitals that scored one star increased by nearly 30 facilities compared with 2023. One hundred fewer hospitals received five stars.

Critical access hospitals and acute care facilities had 24 and 81 fewer five star ratings, respectively. More Veterans Administration hospitals — 35% versus 32% in 2023 — received five stars.

2. Fewer hospitals received ratings

Compared with last year, 227 fewer hospitals were rated. In part, the dip is due to hospitals being unable to report on enough measures for CMS to calculate a star rating.

Critical access hospitals' lower patient volumes coupled with CMS excluding certain reporting periods means the facilities often have a harder time meeting the data threshold necessary to receive a rating, said Akin Demehin, senior director of quality and patient safety policy at the American Hospital Association.

Another possibility is that some critical access hospitals — which aren't required to participate in the star ratings — opted out of having their star rating calculated, he said.

3. Half of hospitals kept the same score

Overall, 51% of hospitals kept the same star rating this year. In large part that's because most facilities are acute care hospitals and they maintained their 2023 star rating.

A lack of changes to CMS’ scoring methodology this year also meant less fluctuation in scores, Demehin said.

Several large hospitals saw their rating slip by two or three stars, including: Staten Island University Hospital in Staten Island, New York; Memorial University Medical Center in Savannah, Georgia; Sutter Roseville Medical Center in Roseville, California; and Kaiser Permanente Sacramento Medical Center in Sacramento, California.

4. Pandemic tailwinds continue to affect performance

Given facilities’ improved efforts around patient experience and care quality since the start of the pandemic, it is slightly surprising that the star ratings are still trending negative, said Rick Kes, a healthcare senior analyst at consultancy RSM.

However, the data used for the 2024 ratings were pulled from different points throughout the pandemic, some during periods when many hospitals were still navigating significant struggles with finances, staffing and high patient acuity, Kes said. 

“The recovery from the pandemic has certainly taken a significant amount of time,” Demehin said.

5. Industry trade groups are pushing for a health equity adjustment

Trade groups including the American Hospital Association have discussed the potential for CMS to introduce social risk factors to its star ratings. Doing so would take into account hospitals in marginalized communities whose patient outcomes measures are affected by disproportionate rates of homelessness, disability and lack of access to care.

CMS' Hospital Value-Based Purchasing Program, for example, has a health equity adjustment that takes both a facility’s quality performance and patients’ social drivers of health into consideration to determine how a hospital is performing for the communities it serves.