Send to

Choose Destination
BMJ Qual Saf. 2019 Jun;28(6):486-494. doi: 10.1136/bmjqs-2018-008384. Epub 2018 Dec 8.

Patterns of performance and improvement in US Medicare's Hospital Star Ratings, 2016-2017.

Author information

General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA.



Publicly reported quality data can help consumers make informed choices about where to seek medical care. The Centers for Medicare and Medicaid Services developed a composite Hospital Compare Overall Star Rating for US acute-care hospitals in 2016. However, patterns of performance and improvement have not been previously described.


To characterise high-quality and low-quality hospitals as assessed by Star Ratings.


We performed a retrospective cross-sectional study of 3429 US acute-care hospitals assigned Overall Star Ratings in both 2016 and 2017. We used multivariable logistic regression models to identify characteristics associated with receiving 4 or 5 stars.


Small hospitals were more likely to receive 4 or 5 stars in 2016 (33% of small hospitals, 26% of medium hospitals and 21% of large hospitals, OR for medium 0.78, p=0.02, and for large, 0.61, p=0.003). Non-profit status (OR 1.37, p=0.01), midwest region (OR=2.30, p<0.001), west region (OR 1.30 in 2016, p=0.06) and system membership (OR 1.33, p=0.003) were associated with higher odds of achieving a higher Star Rating. Hospitals with the most Medicaid patients were markedly less likely to receive 4 or 5 stars (OR for highest quartile=0.32, p<0.001), and hospitals with the highest proportion of Medicare patients were somewhat less likely to do so (OR for highest quartile=0.68, p=0.01). These associations remained largely consistent over the first two years of reporting and were also associated with the highest likelihood of improvement.


Small hospitals with fewer Medicaid patients had the highest odds of performing well on Star Ratings. Further monitoring of these trends is needed as patients, clinicians and policymakers strive to use this information to promote high-quality care.


health policy; healthcare quality improvement; quality measurement


Conflict of interest statement

Competing interests: KJM was supported by the National Heart, Lung, and Blood Institute under grant K23-HL109177-03.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center