CMS star ratings and the Care Compare tool at Medicare.gov let you compare hospitals, nursing homes, doctors, home health agencies, and dialysis centers using the same standardized measures rather than reputation. Each provider gets a rating from 1 to 5 stars built from patient experience surveys and clinical outcome data, and the individual measures beneath that star are usually more useful than the star itself when you are choosing where to get care.1Centers for Medicare & Medicaid Services. Hospital CAHPS (HCAHPS)
Where to Find the Ratings
All of the data lives at Medicare.gov’s Care Compare tool, which replaced several older sites (Hospital Compare, Nursing Home Compare, and others) with a single platform.2Medicare.gov. Find Healthcare Providers: Compare Care Near You You can search by provider name, facility type, or location, pull up an individual profile, and set two or more facilities side by side.
Each profile leads with the star rating, but the useful material is below it: the specific measures that built the rating, how the facility compares to national benchmarks, and data broken out by condition or procedure. Hospitals have the most detailed reporting. Smaller outpatient providers often have less.
What the Ratings Are Built From
Two kinds of data feed the ratings. Patient experience comes from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys, most prominently the 22-question HCAHPS survey given to patients after hospital stays.3Centers for Medicare & Medicaid Services. HCAHPS: Patients’ Perspectives of Care Survey Because every hospital uses the same questions, results are directly comparable rather than each facility grading itself on its own curve.4HCAHPS Online. HCAHPS Home The survey asks about specific care processes: whether nurses and doctors communicated clearly, how quickly staff responded to the call button, whether new medications and their side effects were explained, and whether discharge instructions were understandable.
The other half is clinical: complication rates, healthcare-associated infection rates, readmission rates for specific conditions, and whether hospitals followed evidence-based care guidelines. This data comes from claims records, clinical reporting systems, and infection tracking databases, not from patient surveys.
How Hospital Star Ratings Work
The Overall Hospital Quality Star Rating condenses dozens of measures into a single 1-to-5 score. Five stars means performance substantially above the national average; one star means substantially below.5Centers for Medicare & Medicaid Services. Overall Hospital Quality Star Rating The score pulls from five measure groups with fixed weights:
- Mortality: 22% (death rates for conditions like heart attack, heart failure, and pneumonia)
- Safety of Care: 22% (surgical complications and healthcare-associated infections)
- Readmission: 22% (how often patients return within 30 days of discharge)
- Patient Experience: 22% (HCAHPS survey results)
- Timely and Effective Care: 12% (whether recommended treatments were delivered promptly)
Outcomes and patient experience together dominate the score, so a hospital cannot earn five stars by being efficient alone if its mortality or readmission numbers are poor.5Centers for Medicare & Medicaid Services. Overall Hospital Quality Star Rating
Not every hospital receives a star rating. A hospital must report at least three measures across at least three of the five groups, and one of those groups must be Safety of Care or Mortality.5Centers for Medicare & Medicaid Services. Overall Hospital Quality Star Rating Specialty and very small hospitals sometimes fall below these thresholds and will show individual measure data with no overall star.
How Nursing Home Star Ratings Work
Nursing home ratings use a completely different method, which trips people up. The overall star is built from three component ratings: health inspections, staffing, and quality measures.6Centers for Medicare & Medicaid Services. Five-Star Quality Rating System
The health inspection rating is the baseline. If staffing is five stars, one star gets added; if staffing is one star, one star gets subtracted. The same adjustment happens for quality measures. So the overall rating can move up or down by as much as two stars from the inspection baseline, but inspections carry the most weight by design.7Centers for Medicare & Medicaid Services. Design for Care Compare Nursing Home Five-Star Quality Rating System
There is a safeguard on top of that. If a nursing home earns a one-star inspection rating, its overall score can be upgraded by no more than one star total, no matter how good its staffing and quality scores are. The reasoning is that trained inspectors found serious, recent problems onsite, and self-reported data should not override that finding.7Centers for Medicare & Medicaid Services. Design for Care Compare Nursing Home Five-Star Quality Rating System
Staffing comes from Payroll-Based Journal (PBJ) data submitted quarterly. It reflects actual payroll hours worked by registered nurses, licensed practical nurses, certified nurse aides, and other direct care staff rather than self-reported estimates.8Centers for Medicare & Medicaid Services. Staffing Data Submission Payroll Based Journal (PBJ) When reviewing a nursing home, look at all three components rather than just the overall star. A four-star home built on a two-star inspection plus five-star staffing tells a very different story from a four-star home with strong inspections across the board.
Doctor and Clinician Profiles
Care Compare also profiles individual doctors and clinician groups. The data draws primarily from the Merit-based Incentive Payment System (MIPS), which evaluates doctors on quality measures, electronic health record use, and improvement activities.9Centers for Medicare & Medicaid Services. Care Compare: Doctors and Clinicians Initiative A clinician profile can show quality measure star ratings, whether the clinician uses certified electronic health record technology, improvement activities the clinician has undertaken, patient survey scores for groups that participate, and procedure volume.
Volume data covers 19 common procedures, including hip and knee replacement, cataract surgery, colonoscopy, coronary angioplasty, and hernia repair.9Centers for Medicare & Medicaid Services. Care Compare: Doctors and Clinicians Initiative Volume is not a direct measure of quality, but research consistently links higher procedure volume to better outcomes for complex surgeries. A surgeon who performs 200 knee replacements a year usually has different complication rates than one who does 15.
One flag worth watching: if a clinician has restricted patients’ access to their own electronic health information, Care Compare displays a caution sign on the profile.10Medicare.gov. Understanding MIPS Quality Performance Measures That is unusual and worth investigating before choosing that provider.
Home Health and Dialysis Providers
Home health agencies receive two separate star ratings: Quality of Patient Care and Patient Survey. The quality rating is based on seven measures covering whether patients improved in walking, bathing, transferring in and out of bed, and managing oral medications, along with whether care started promptly and whether the patient ended up in the hospital during the home health stay.11Centers for Medicare & Medicaid Services. Home Health Star Ratings The patient survey rating comes from a CAHPS survey specific to home health. Agencies need at least 40 completed surveys to receive that star. Smaller agencies may show survey data without a star.
Dialysis centers also carry star ratings on Care Compare. The clinical data comes from Medicare claims, the End Stage Renal Disease Quality Reporting System, and infection tracking through the National Healthcare Safety Network. Patient experience uses a CAHPS survey administered to in-center hemodialysis patients twice a year.12Centers for Medicare & Medicaid Services. Dialysis Facility Care Compare Quick Guide
Reading Beyond the Star
Two hospitals with the same three-star rating can have very different strengths, and the specific measures underneath are where you learn which one fits your situation. Three areas are usually worth checking directly.
Healthcare-Associated Infections
Care Compare reports infection rates tracked through the CDC’s National Healthcare Safety Network, including central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI).13Centers for Medicare & Medicaid Services. Healthcare Associated Infections – Hospital These use a standardized infection ratio that compares the hospital’s actual count to what a risk-adjusted model predicted. A ratio below 1.0 means fewer infections than expected; above 1.0 means more.14U.S. Department of Health and Human Services. National HAI Targets and Metrics Infection numbers are among the most actionable on the site because hospital-acquired infections vary significantly between facilities.
Readmission Rates
CMS tracks 30-day unplanned readmission rates for six conditions and procedures: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, coronary artery bypass graft surgery, and elective hip or knee replacement.15Centers for Medicare & Medicaid Services. Hospital Readmissions Reduction Program High rates for a specific condition often point to problems with initial treatment, discharge planning, or follow-up. The rates are risk-adjusted, so a hospital treating sicker patients is not automatically penalized.
Patient Experience Breakdowns
Rather than the overall HCAHPS score, look at the percentage of patients who gave the best possible response for each specific category. You can compare, for example, what percentage of patients said their nurses “always” communicated well at Hospital A versus Hospital B. The “always” threshold is the one CMS publicly reports, so you are seeing the share of patients who had the best experience, not just an adequate one. If you are heading into surgery, communication and discharge instruction scores may matter more to you than the quietness rating.
What the Data Can and Can’t Tell You
CMS refreshes Care Compare quarterly, but what you see reflects care delivered months earlier. Clinician procedure volume, for example, covers a 12-month window with a three-month claims processing delay on top.9Centers for Medicare & Medicaid Services. Care Compare: Doctors and Clinicians Initiative Hospital quality measures can lag further. Recent improvements likely have not landed in the current data yet, and a hospital whose quality has recently declined may still display older, better numbers.
Sample size also matters. CMS sets minimum reporting thresholds, and providers below them either receive no star rating or display a “not enough data available” message. Home health quality star ratings require at least 20 complete quality episodes per measure, and patient survey ratings require 40 or more completed surveys.11Centers for Medicare & Medicaid Services. Home Health Star Ratings A missing star rating does not mean a provider is bad. It often just means the provider is small.
The star ratings also cannot capture everything. They do not reflect bedside manner beyond what survey questions cover, do not distinguish individual surgeons within a hospital, and do not measure outcomes for every possible condition. A three-star hospital can house a world-class cardiac program hidden inside otherwise average scores. Use the star as a screening tool, then dig into the condition-specific data that matches what you actually need care for.