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Patterns of performance and improvement in US Medicare’s Hospital Star Ratings, 2016–2017
  1. Paula Chatterjee1,
  2. Karen Joynt Maddox2
  1. 1 General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2 Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
  1. Correspondence to Dr Paula Chatterjee, General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; pchat{at}


Background 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.

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

Design 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.

Results 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.

Conclusions 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.

  • quality measurement
  • healthcare quality improvement
  • health policy

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The NHLBI played no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

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

  • Patient consent Not required.

  • Ethics approval Institutional Review Board at Washington University in St. Louis.

  • Provenance and peer review Not commissioned; externally peer reviewed.