Hospitals Have a Star Ratings Problem - Here’s How to Fix It

When CMS announced its 2026 Hospital Star Ratings in January, the results were, to put it mildly, uninspiring. On a 5-star rating scale, the majority of U.S. hospitals (58%) scored 3 stars or less. The most common rating was a middle-of-the-road 3 stars (31% of all hospitals).

Among the more than 2,800 hospitals that were rated in both 2025 and 2026, there was some promise: just under one-third of hospitals (29%) saw an uptick in their star rating. But the vast majority of hospitals either maintained (53%) or, worse, decreased their star rating (18%).

So, why are America’s hospital star ratings so remarkably underwhelming? Do hospitals simply need to work harder? Hardly: just ask anyone who’s worked on the frontlines of a U.S. hospital in the last 5 years. No, the answer is not to work harder. The answer is to work smarter.

The Universal Star Ratings Problem

Regardless of a hospital’s size, patient population, or clinical expertise, there is one star ratings challenge that no U.S. hospital can escape: the ratings are incredibly complex.

At surface level, they look deceptively simple. It’s just 1 to 5 stars. But getting to that one score requires aggregating dozens of quality care measures across five separate and differently weighted domains. And it’s not just about how you perform individually; how you compare to other hospitals within your CMS-assigned peer group is also factored into your final rating.

Compounding the problem is that CMS has a history of changing how Hospital Star Ratings are calculated in ways that can be difficult to predict. In any given year, measures may be added or removed and new methodologies can be introduced. For hospitals, that makes knowing where to focus feel like a bit of a guessing game. 

Then there is the ratings lag time. CMS Hospital Star Ratings, by the time they are published, are based on performance data that is typically two to three years old. That means hospital teams are often working blindly, hoping that the improvements they make today will translate into fair and accurate ratings two to three years down the road.

Mediocre Ratings Are Costing Hospitals Now More Than Ever

While it would be nice to write off CMS’s Hospital Star Ratings as just another regulatory report to review, ignoring them is becoming increasingly costly to a hospital’s public reputation and financial performance.

Hospital Star Ratings and the quality care measures that inform them are all publicly reported on Care Compare, CMS’s public-facing website.

These published results can directly impact everything from physician recruitment to payer negotiations. But most importantly, they influence consumer choice. In fact, a recent study showed that patients are willing to pay, on average, $1700 more for a hospital that has a one-star-higher rating in clinical outcomes.

The same measures that are used to calculate star ratings are also, in part, used by almost every other high-profile hospital ranking program today, including U.S. News & World Report’s Best Hospitals rankings and the Leapfrog Hospital Safety Grades. The ripple effect of a lackluster star rating is significant.

So, Is There Anything Hospitals Can Do? Yes

Solving the star ratings problem starts with reframing how the ratings are viewed, managed, and prioritized within a hospital’s culture and its operations. And that reframing needs to come from the very top: from the leadership team.

• Stop Treating Star Ratings Like a Report Card
  

  Many hospitals treat star ratings like a retrospective report card. The rating is released, leadership reacts to the number, and teams scramble to explain what happened after the fact. Hospitals who look at star ratings as something that must be actively and proactively managed throughout the year will be the ones to beat.

• Think Outside the Quality Department
  

  It’s not uncommon for hospitals to write off star ratings improvement as a quality department problem. In reality, the quality care measures that make or break a hospital’s star rating touch everything from sepsis protocols to nurse communication to discharge planning. Quality can't own this issue alone; it requires hospital-wide engagement.

• Make Improvement Strategic
  

  It would be understandable for a hospital to look at its worst-performing measures and think, “That’s our focus this year,” but that’s only factoring in one side of the 10-sided die that is star ratings.

Hospitals need to look at the program comprehensively and identify the smartest opportunities for improvement from a strategic point of view. Which of our measures are trending in the right direction? Are we on pace to achieve a significant enough leap forward? Are we trending fast enough to outpace the national rate? In other words, there are many questions you need to answer when choosing which measures to focus on, and the right answers may not always be the obvious ones.

Hospitals Can’t Be Expected to Do This Alone

While the reframing by leadership is important, that alone can’t solve the problem. The complexities of the star ratings system require a level of data analysis that most hospital aren’t equipped to handle on their own. It will be up to the healthcare technology industry to help hospitals bridge the gap.

In 2025, Medisolv took the challenge head on with development of a new Hospital Star Rating Analyzer, which publicly launched on February 20th.

I kept hearing the same frustration from hospitals: “We know our rating, but we don’t know where to start.” Existing tools on the market could show scores, but they didn’t provide direction. It became clear that hospitals needed more support identifying where to focus, what to deprioritize, and how to take action before the next CMS refresh, not after it.

An Inside Look at the Hospital Star Ratings Analyzer

Medisolv’s Hospital Star Rating Analyzer shifts hospitals into proactive status, allowing users to start with the big picture—their overall rating and summary score—and then drill down to see exactly which measure groups and specific measures are contributing positively or negatively to their results. From there, a quality team can quickly identify their high-priority, high-impact opportunities without having to manually analyze dozens of measures.

• The module’s predictive forecasting engine shows hospitals their likely star rating two years out based on their current performance trajectories.
• A goal achievement calculator allows hospitals to set their target star rating and then calculates the exact measure performance rates that need to be achieved to get there.
• Tracking tools make it easy for hospitals to evaluate their performance against national averages over time, monitor the acceleration and deceleration patterns of their own performance, and compare themselves against self-selected peer hospitals.
• Using the module’s measure prioritization tool, hospitals can score each measure based on feasibility, population impact, strategic alignment, and value-based program alignment. The tool then auto-ranks the measures to show hospitals which ones to focus on first.

The Hospital Star Rating Analyzer also allows teams to model scenarios. They can ask, “What if we improve this measure by X amount?” and immediately see how that change would affect their overall rating. That level of visibility helps teams understand the relative value of different improvement efforts and make informed trade-offs about where to invest their time and energy.

Hospitals Shouldn’t Be Afraid to Seek Outside Expertise

While technology will be a critical gap-filler for hospitals looking to improve their star ratings, human expertise shouldn’t be undervalued either. But few hospitals have the resources for a dedicated star ratings manager on staff. Looking to outside support, like Medisolv’s Advisory Services, can help.

While the Medisolv Hospital Star Rating Analyzer pinpoints where you should focus your improvement efforts, our Advisory Services team works with you to determine how to improve those measures at a clinical and operational level.

For one Arkansas-based hospital, the clinical and operational deep-dive was a game-changer. After helping the hospital strategically pinpoint CLABSI as one of the primary measures that could drive ratings improvement, Medisolv advisors worked closely with the hospital's newly formed, cross-departmental Zero CLABSI team to audit and overhaul the hospital’s entire approach to central line care. From that, a host of new processes (daily central line reports), policies (no central line blood draws), and programs (mandatory CLABSI training sessions) were born.

Because star ratings are so complex, it’s easy for hospitals to get stuck between awareness and action. You may know your star rating, and even which domain hurt you, but translating that into clear, prioritized initiatives is difficult. By combining technology with human expertise, we give hospitals the intelligence they need to channel their efforts into focused initiatives that will materially impact their ratings and their public reputation.

Passive Monitoring Is No Longer an Option

Ultimately, hospitals can no longer afford to sit on the sidelines with CMS’s hospital star ratings. The costs are growing, and so is the competition.

As more hospitals invest in improvement, the bar continues to rise on comparison scoring. A hospital that may have been comfortably at 4 stars just a few years ago could now be at risk of dropping to 3 stars without active management. If you’re not paying attention now, you should be.