When the Centers for Medicare & Medicaid Services posted its Star Ratings on the Hospital Compare website for the first time, only 5% of hospitals received the highest five-star rating.

The majority of the 3,553 hospitals rated received two or three stars (56%), with 34% getting four stars and 3% getting just one star.1

The ratings, published in April, were based on responses of patients discharged between July 1, 2013, and June 30, 2014. CMS plans to update the HCAHPS Star Ratings quarterly.1

The Star Ratings give consumers a quick visual about a hospital’s rating. However, the Star system is based totally on patient evaluations and doesn’t include other indicators of quality. The questions are subjective and measure only the patient’s perception of care, points out Wanda Pell, MHA, BSN, director, Novia Strategies, a national healthcare consulting firm.

She predicts that informed consumers will not rely totally on the Star Ratings when they choose a hospital.

Like Value-based Purchasing, the readmission reduction program, and the hospital-acquired condition reduction program, the Star Ratings are based on data from a couple of years ago, says John Zelem, MD, FACS, vice president, compliance and physician education at Executive Health Resources, a Newtown Square, PA, consulting firm.

If hospitals are doing better now than they were a year ago, it won’t show up for at least a couple of years, he adds.

HCAHPS can be implemented in four survey modes: mail, telephone, mail with telephone follow-up, or active interactive voice recognition, each of which requires multiple attempts to contact patients, Zelem says. Hospitals must survey patients throughout each month of the year. Hospitals paid under the Inpatient Prospective Payment System (IPPS) must achieve at least 300 completed surveys over four quarters. HCAHPS is not restricted to Medicare patients, he adds.

“Everything is relevant. If patients have just one bad thing happen during their hospital stay, they may give negative answers to all the questions,” he says.

The Star Rating system is just one tool among many that patients can use when making healthcare decisions, says Akin Demehin, senior associate director of policy for the American Hospital Association.

“While Star Ratings could be an effective way to make quality information easier to understand, the devil is in the details. There is a risk of oversimplifying the complexity of quality of care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons,” he adds.


  1. HCAHPS Summary Star Rating. www.hcahpsonline.org. Centers for Medicare & Medicaid Services, Baltimore, MD. Accessed May 20, 2015.