What to know when comparing hospitals by state: A Data-Based Guide to Quality, Safety, and Limitations

Comparing hospitals by state requires separating broad geographic patterns from the performance of an individual facility. National datasets can provide a consistent starting point, but ratings must be interpreted alongside the hospital’s services, patient population, reporting period, and the urgency of the medical need.

How statewide hospital comparisons are constructed

CMS Care Compare organizes standardized information for Medicare-certified hospitals, including overall quality ratings and individual measures. A recent CMS-based snapshot covered 5,426 hospitals across 56 states and territories, but only 2,866 hospitals had an overall star rating, meaning approximately 52.8% of the hospitals in that dataset were rated. The reported average overall rating was 3.08 out of 5. 1

A state average can therefore describe the rated portion of a healthcare market rather than every hospital operating there. Differences in the number of hospitals, the mix of urban and rural facilities, and the share of institutions with sufficient reporting data can affect comparisons. A statewide ranking should be treated as context, not as proof that every hospital in one state performs better than every hospital in another.

What the CMS star rating does and does not show

The CMS Overall Hospital Quality Star Rating condenses dozens of measures into a one-to-five-star summary. The underlying categories include mortality, safety of care, readmissions, patient experience, and timely or effective care. In the reported distribution, 32.6% of rated hospitals received three stars, 26.7% received four stars, 22.6% received two stars, 10% received five stars, and 8% received one star. 2

Because most rated hospitals cluster around three and four stars, a one-star difference should not be interpreted as a complete description of clinical capability. The summary may also conceal meaningful differences between departments. A hospital can perform strongly in one service line while showing average results in another, so condition-specific data is more relevant than the overall score for a planned procedure.

• Review mortality and readmission measures for the relevant condition.
• Check safety indicators, including infections and preventable complications.
• Consider patient experience separately from clinical outcomes.
• Confirm that the displayed reporting period is current enough for the decision.

Why patient experience requires careful comparison

HCAHPS surveys measure how patients describe communication, responsiveness, cleanliness, medication explanations, discharge information, and willingness to recommend a hospital. These measures provide a distinct view from mortality or infection statistics. Comparisons can become misleading when hospitals serve materially different patient populations or when one facility has a different case mix, specialty profile, or survey volume. 3

Single-period results can also overstate small changes. A more useful review compares multiple reporting periods and examines both top-box results and broader score distributions where available. Patient experience is important, but it should not replace clinical evidence, especially when evaluating complex surgery, intensive care, trauma, cancer treatment, or other specialized services.

Safety grades, accreditation, and specialty rankings

Hospital comparison tools do not measure identical concepts. The Leapfrog Hospital Safety Grade assigns an A through F letter grade focused on preventing medical errors, injuries, accidents, and infections. CMS includes safety among several broader quality domains, while accreditation from The Joint Commission indicates that a facility meets applicable national standards. These designations can complement one another, but they are not interchangeable scores. 4

U.S. News rankings emphasize specialty-specific outcomes, objective clinical data, and reputation, which can produce a different result from a general CMS rating. A hospital’s national reputation may reflect advanced services that are not captured by a general facility score. Reviewing the methodology behind each rating is essential before treating two grades as direct equivalents.

• CMS: broad hospital quality summary and underlying measures.
• Leapfrog: patient safety and error-prevention emphasis.
• Joint Commission: accreditation and compliance baseline.
• U.S. News: specialty-oriented outcomes and reputation measures.

State differences, risk adjustment, and reporting limits

State-to-state comparisons are influenced by regional differences in demographics, socioeconomic conditions, insurance coverage, public health, and patterns of hospital use. Risk adjustment attempts to account for differences in patient severity, but no adjustment eliminates every contextual difference. State health departments may also require reporting that is more detailed than national datasets, while healthcare-associated infection requirements and publication practices can vary by jurisdiction. 5

Some published state tables use a different methodology from CMS star averages. For example, one state comparison reports the percentage of hospitals receiving an A safety grade in spring 2023. New Jersey was listed at 51.5%, Idaho at 50%, Utah at 48.1%, Pennsylvania at 46.5%, and Connecticut at 42.9%. Those figures should not be combined with CMS averages because they represent a different grade, date, and measurement framework. 6

Ownership, location, volume, and the practical decision

The analyzed CMS data described differences associated with ownership and operating models, including stronger performance among Veterans Affairs and nonprofit hospitals than for-profit facilities in the reported comparison. Such patterns are population-level observations, not guarantees about an individual institution. Rural hospitals, teaching centers, specialty hospitals, and large referral hospitals also operate under different constraints, making direct comparisons difficult without examining service mix and case volume. 1

For emergency symptoms such as suspected heart attack, stroke, or serious trauma, proximity and the nearest appropriate emergency capability are central because delay can affect care. Planned treatment allows more evaluation of procedure volume, surgeon experience, infection rates, condition-specific mortality, patient experience, insurance participation, travel requirements, and expected charges. Prices vary substantially: a 2026 report found an average sevenfold difference between the least and most expensive hospitals across 25 tracked procedures, with an eightfold maximum ratio for several procedures. 7

• Match the hospital to the medical condition and required specialty.
• Compare condition-specific outcomes before relying on the overall star score.
• Review safety, infection, readmission, mortality, and patient-experience measures together.
• Account for distance, emergency capability, coverage, and likely financial responsibility.
• Check the reporting date and avoid treating missing ratings as proof of poor quality.

Where to verify information and what to avoid

Medicare’s Care Compare is the federal comparison platform and presents hospital ratings alongside more than 130 individual measures covering outcomes, safety, patient experience, emergency department efficiency, and imaging appropriateness. Provider Data Catalog files may support deeper comparisons than the public summary view. 8 State health departments, the CDC’s National Healthcare Safety Network, and AHRQ reports can add regional context to infection, quality, and disparity questions.

The main risks are relying on an outdated score, comparing hospitals with different missions, confusing accreditation with superior outcomes, or treating a statewide average as a facility-level conclusion. A balanced review uses several measures, identifies the relevant reporting period, recognizes missing data, and considers whether the hospital is equipped for the specific clinical situation. No single ranking captures every dimension of hospital care.

Sources

1. OurHealthNetwork, “Hospital Quality Rankings by State: CMS Star Ratings Analyzed”
2. Fonteum Care Compare, “Hospitals: CMS Quality by State”
3. NRC Health, “HCAHPS Scores by Hospital: How to Compare Facilities”
4. LegalClarity, “How to Compare Hospital Performance: Ratings and Tools”
5. American Hospital Association, guidance on healthcare quality and risk adjustment
6. World Population Review, “Hospital Rankings by State 2026”
7. HospitalCostData, “The Hospital Price Gap Report 2026”
8. Medicare.gov, “Care Compare”