Hospitals in the United States are rated by several independent systems, each measuring different things. The federal government assigns one-to-five star ratings through CMS (Centers for Medicare & Medicaid Services), while private organizations like U.S. News & World Report, Leapfrog, and Healthgrades publish their own rankings using different methods. Because these systems weigh different factors, the same hospital can score well on one and poorly on another.
The Federal Government’s Star Ratings
The most widely referenced rating comes from CMS, which evaluates over 4,000 Medicare-certified hospitals and publishes results on its Care Compare website. The 2025 rating uses 45 quality measures organized into five groups, each contributing a specific percentage to the overall score:
- Mortality (22%): How often patients die within 30 days of being admitted for conditions like heart attack, heart failure, stroke, pneumonia, and COPD, or after procedures like bypass surgery.
- Safety of care (22%): Rates of hospital-acquired infections, surgical complications, and other preventable harm.
- Readmission (22%): How often patients end up back in the hospital shortly after being discharged.
- Patient experience (22%): Survey results from patients about their actual stay.
- Timely and effective care (12%): Whether hospitals follow evidence-based treatment steps and deliver care without unnecessary delays.
CMS calculates a weighted average from these five groups, then uses a statistical clustering method to sort hospitals into peer groups and assign one to five stars. This means there’s no fixed cutoff score for each star level. Instead, the algorithm groups hospitals with similar overall performance together.
What Patient Experience Surveys Measure
Every rating system draws on the same patient survey, called HCAHPS. It’s a standardized 22-question questionnaire given to a random sample of recently discharged patients at virtually every hospital in the country. The questions cover 10 core areas: communication with nurses, communication with doctors, responsiveness of staff, hospital cleanliness, quietness of the environment, communication about medications, discharge information, care coordination, information about post-discharge symptoms, and an overall rating of the hospital.
These scores carry real weight. In the CMS system, patient experience accounts for 22% of the total score, the same share as mortality or safety. That means a hospital with excellent clinical outcomes but poor communication and a noisy, disorganized environment will see its star rating dragged down. You can view these survey results separately on Medicare’s Care Compare tool, which lets you place hospitals side by side and compare their patient experience scores directly.
U.S. News & World Report Rankings
U.S. News takes a different approach by ranking hospitals within specific medical specialties, like cardiology, orthopedics, or cancer care. Each hospital receives a score from 0 to 100 based on four elements: patient outcomes (45%), other care-related indicators like nurse staffing levels and breadth of services (35%), patient experience (5%), and expert opinion gathered from physician surveys.
The heavy emphasis on outcomes and structural factors means this system tends to favor large academic medical centers with specialized resources, high patient volumes, and strong research reputations. A community hospital might deliver excellent routine care but rank lower simply because it doesn’t offer rare procedures or attract specialist survey votes. If you’re facing a complex diagnosis and want to know which hospitals handle it most often with the best survival rates, U.S. News is designed for that question. For everyday hospital care, it’s less useful.
Leapfrog Safety Grades
The Leapfrog Group focuses exclusively on patient safety, assigning letter grades from A through F twice a year. Their scoring uses up to 22 measures split evenly between two categories: process and structural measures (which assess what a hospital does to prevent errors) and outcome measures (which track what actually goes wrong).
The outcome measures are specific and concrete. Leapfrog tracks rates of bloodstream infections from central lines, urinary tract infections from catheters, surgical site infections from colon surgery, MRSA blood infections, C. diff infections, objects accidentally left inside patients after surgery, air entering the bloodstream, patient falls that cause injury, and death rates among surgical patients who develop serious but treatable complications. Half of your hospital’s letter grade comes from these outcomes alone.
Leapfrog’s narrow focus on safety makes it particularly useful if you’re heading into surgery or an extended hospital stay where infection risk matters most. A hospital with a C grade from Leapfrog might still earn four stars from CMS if its mortality rates and patient experience scores are strong.
Healthgrades Ratings
Healthgrades analyzes over 45 million Medicare claims records across the most recent three-year period available for roughly 4,500 hospitals. Their method compares what actually happened to patients against what was predicted to happen, given each patient’s age, health conditions, and risk factors.
The process works in four steps. First, Healthgrades determines whether a hospital visit resulted in a complication or death, tracking outcomes for 30 days after care. Second, they build a risk profile for each patient based on their existing health conditions. Third, they create a statistical model predicting the expected outcome for patients with those same conditions. Finally, they compare predicted outcomes to actual outcomes and assign star ratings based on whether the hospital performed better or worse than expected. This risk-adjustment approach means a hospital treating sicker patients isn’t automatically penalized for having worse raw numbers.
Joint Commission Accreditation
The Joint Commission operates differently from the rating systems above. Rather than ranking hospitals against each other, it sets baseline safety and quality standards that hospitals must meet. Accreditation from the Joint Commission satisfies federal requirements for participating in Medicare and Medicaid, and most states accept it in place of their own routine inspections. Hospitals that pass earn a “Gold Seal of Approval.”
Think of accreditation as a pass/fail threshold rather than a quality ranking. A hospital without Joint Commission accreditation (or an equivalent) generally cannot receive Medicare payments, so nearly every hospital you’d visit has cleared this bar. It tells you a hospital meets minimum standards for things like infection control, medication management, and emergency preparedness. It doesn’t tell you how that hospital compares to the one across town.
Why Ratings Disagree
It’s common for a hospital to earn five stars from CMS, a B from Leapfrog, and a middling U.S. News ranking all at the same time. This happens because each system asks a fundamentally different question. CMS balances five dimensions equally (with a slight de-emphasis on timely care). U.S. News puts 45% of its weight on outcomes and only 5% on patient experience. Leapfrog ignores mortality and patient satisfaction entirely, focusing only on safety.
There are also known biases in the underlying data. Hospitals that serve lower-income populations or patients with more complex social circumstances tend to have higher readmission rates and lower patient experience scores, not necessarily because the clinical care is worse but because factors like housing instability, transportation access, and language barriers affect both recovery and survey responses. These effects can pull down a safety-net hospital’s overall rating even when its medical care is comparable to better-scoring peers.
How to Use These Ratings Practically
Medicare’s Care Compare tool at medicare.gov is the most straightforward starting point. It covers over 4,000 hospitals including VA and military facilities, lets you compare them side by side, and breaks out individual scores so you can see exactly where a hospital is strong or weak. You can look at patient survey ratings separately from clinical outcomes, which helps if you care more about one than the other.
For a planned surgery, checking Leapfrog’s safety grade gives you a focused look at infection rates and surgical complications. For a serious diagnosis in a specific specialty, U.S. News rankings can help identify hospitals with the deepest experience. Healthgrades is useful for procedure-specific comparisons, since it breaks outcomes down by individual conditions and surgeries rather than giving a single overall score.
No single rating captures everything that matters about a hospital. Using two or three systems together, and paying attention to the specific measures rather than just the headline score, gives you a much clearer picture than relying on any one number or letter grade alone.