Understanding the Hospital Grading System

Choosing a hospital can feel overwhelming, especially when you’re making decisions during a stressful or unexpected health situation. While word-of-mouth recommendations are a helpful start, many patients need a clearer picture of how a hospital performs.

Hospital grading systems were developed because most patients lack the time or expertise to sort through dozens of hospital quality measures on their own. Instead, these programs combine data on issues such as patient safety, outcomes, and readmissions into scores that are easier to review and compare.

This guide is an introduction to hospital grading systems, explaining how they work and what patients should consider when using these tools to make informed decisions about their care.

CMS Star Ratings and Leapfrog Safety Grades are two of the most widely recognized hospital rating systems in the U.S.
Hospital grades are built using standardized performance measures, ranging from patient outcomes to infection prevention and patient feedback.
Different grading systems use different methodologies, which can result in varying scores for the same hospital.
Patients can compare hospitals online through public resources, allowing them to make more informed healthcare decisions.
Understanding how these ratings are calculated can help patients interpret hospital grades more effectively.

How Do Hospital Grading Systems Work?

Hospital grading systems evaluate performance measures using publicly available data. Factors can include quality of care, patient safety, treatment outcomes, and other data points. Organizations such as the Centers for Medicare & Medicaid Services (CMS) and The Leapfrog Group collect, analyze, and publish hospital performance data using their own methodologies and evaluation criteria.

Much of the information used in hospital grading systems comes from government reporting programs, patient surveys, and safety databases. These organizations collect that information and present it in a format that allows patients to compare hospitals without having to review hundreds of pages of raw data.

Hospital grades can be a helpful starting point for finding healthcare, but they shouldn’t be viewed as the final word on quality. Because organizations use different criteria and methodologies, the same hospital may perform differently across various grading systems.

The Two Most Widely Recognized Hospital Rating Systems

While several organizations collect and publish information about hospital performance, CMS and The Leapfrog Group are among the most widely recognized sources of hospital quality and safety data in the United States.

CMS Overall Star Ratings

Federal hospital quality ratings that compare hospitals assign an overall score ranging from one to five stars based on patient outcomes, safety, readmissions, and patient experience. Ratings are updated annually.

Leapfrog Safety Grades

Independent patient safety ratings that assign hospitals a letter grade from A to F using 32 evidence-based safety measures. Grades are updated twice each year.

Both organizations, discussed in greater detail below, use some of the same underlying hospital data, but they prioritize different measures. It’s not unusual for a hospital to earn a strong score from one organization and a more modest score from the other.

Understanding CMS Hospital Star Ratings

The CMS star ratings were designed to make hospital comparisons easier for patients. Rather than reviewing dozens of individual performance measures, patients can use the star rating to evaluate how a hospital performs as compared to others nationwide.

The Five Quality Categories Used in CMS Ratings

CMS calculates Overall Hospital Quality Star Ratings using measures grouped into five categories. Each category is weighted before calculating a hospital’s overall rating.

Mortality
Safety of care
Readmission
Patient experience
Timely and effective care

Measure group

Weight used in calculation

Mortality

22%

Safety

22%

Readmission

22%

Patient Experience

22%

Timely & Effective Care

12%

How Do Hospitals Receive a Star Rating?

To qualify for a star rating, a hospital must report performance data across multiple quality categories. As a result, not every hospital receives a CMS Overall Hospital Quality Star Rating. Once a hospital has a star rating, CMS uses the reported data to create more meaningful comparisons among similar facilities.

Not every hospital generates the same amount of reportable data, which can affect how ratings are calculated. Factors such as the services a hospital provides and the patients it treats can influence its rating. Therefore, hospital star ratings are a good starting point for comparing facilities, but should not be the only factor when making a healthcare decision.

Analyzing the CMS Five-Star Rating Scale

CMS assigns hospitals a rating ranging from one to five stars, with five stars representing the strongest overall performance. One star represents the weakest relative performance among rated hospitals.

Five stars: Highest-performing hospitals
Four stars: Above-average performance on a national scale
Three stars: Performance comparable to the national average
Two stars: Below-average performance on a national scale
One star: Lowest-performing hospitals

According to CMS’s April 2026 data, approximately 31% of hospitals received three stars, while only 12% received five stars. Because the ratings are relative rather than based on a fixed passing score, earning five stars is relatively uncommon.

Overall Rating

Number of hospitals (N=4,609)

1 star

233 (8.1%)

2 star

661 (22.9%)

3 stars

939 (32.5%)

4 stars

767 (26.5%)

5 stars

291 (10.1%)

Understanding Leapfrog Hospital Safety Grades

While CMS evaluates hospitals across a range of quality measures, Leapfrog Group focuses specifically on patient safety. Through its Hospital Safety Grade program, Leapfrog assigns letter grades based on how effectively facilities protect patients from preventable harm during their care.

Leapfrog Letter Grades for Hospital Safety

The Leapfrog Hospital Safety Grade is the only national hospital rating program focused exclusively on patient safety. Updated each spring and fall, the program evaluates hospitals using up to 32 evidence-based measures related to preventable errors and patient safety.

Unlike CMS’s five-star system, Leapfrog assigns hospitals a letter grade from A to F. The methodology is developed with input from patient safety experts and incorporates both publicly reported data and information collected through Leapfrog’s hospital survey programs. The resulting grade reflects how a hospital performs on measures tied to preventable patient harm, including infections, complications, and safety-related practices.

How Leapfrog Measures Patient Safety

Leapfrog evaluates hospital safety using two categories of measures, each accounting for 50% of a hospital’s overall score. Together, these categories are intended to assess both the systems hospitals have in place to promote safety and the outcomes patients actually experience during their care.

Two Domains of Safety Evaluation

Process and Structural Measures (50%): Evaluate the policies, procedures, technology, and safety practices hospitals use to help prevent errors before they occur. Examples include staff responsiveness, medication safety systems, and other evidence-based patient safety protocols.
Outcome Measures (50%): Evaluate what happens to patients during care, including complications and safety concerns that arise.

What Leapfrog Grades Mean

Leapfrog assigns hospitals a letter grade ranging from A to F based on their overall patient safety performance.

A: Among the strongest patient safety performers
B: Above-average patient safety performance
C: Average patient safety performance
D: Below-average patient safety performance
F: Among the lowest patient safety performers

Because the grades are based on a relative scoring methodology, not every hospital can receive an A. In Fall 2025, only 358 hospitals nationwide maintained an A grade for more than two years and earned Leapfrog’s “Straight A” designation, representing approximately 13% of eligible hospitals.

Key Hospital Quality Measures Patients Should Understand

Hospital grading systems evaluate more than one aspect of care. Some measures focus on clinical outcomes, while others examine patient safety, recovery, and the overall care experience.

Mortality Measures

Mortality measures look at how often patients die within a certain period after being treated for specific serious conditions or procedures. CMS began publicly reporting 30-day mortality rates for heart attack and heart failure in 2007, then added pneumonia-related mortality measures in 2008.

These measures are used to evaluate outcomes for conditions where hospital care can significantly affect survival. Lower mortality rates generally suggest stronger outcomes, though it’s still important to consider the hospital’s specialties, case complexity, and available services.

Readmission Rates

Readmission rates measure how often patients return to the hospital after being discharged. CMS began reporting 30-day readmission rates for heart attack, heart failure, and pneumonia in 2008.

A higher readmission rate can sometimes indicate that patients are leaving the hospital without the support or follow-up care needed for a successful recovery. However, readmission data should be viewed in context, as some hospitals treat more complex patients who may be at higher risk of readmission after discharge.

Hospital-Acquired Infections

Hospital-acquired infections develop in patients while receiving care in a hospital. These measures gathered through the CDC’s National Healthcare Safety Network matter because many healthcare-associated infections can be reduced when hospitals follow recommended infection control practices. Lower infection rates often indicate that a hospital consistently follows practices designed to reduce preventable infections.

Patient Experience Measures

Patient experience measures come from the HCAHPS Survey, a national, standardized survey that collects patients’ perspectives on hospital care. The survey asks discharged patients about communication with doctors and nurses, staff responsiveness, cleanliness, discharge instructions, overall hospital rating, and whether they would recommend the hospital.

These scores provide insight into aspects of care that don’t always appear in clinical outcome data. A hospital may perform well on medical outcomes but still have lower patient experience scores if patients report poor communication, slow response times, or confusion about care instructions after discharge.

How to Interpret and Compare Hospital Ratings

Hospital grades can be useful, but they should not be treated as the only factor in choosing where to receive care. A single rating may reflect many different measures, and two hospitals with the same overall score may have very different strengths and weaknesses.

When comparing hospitals, it helps to look at the details behind the grade and consider whether the rating reflects the type of care that matters most for your situation.

Know What You Are Comparing in a Hospital Rating

An overall grade can provide a quick snapshot of performance, but it does not explain why a hospital received that score. Before relying on a rating, patients should look at what the grade measures and whether those measures apply to the care they need.

What To Consider When Comparing Hospitals:

The hospital’s specific strengths and weaknesses, not just the overall grade
Whether the hospital reports data relevant to your specific condition
The hospital’s track record over multiple years, not just a single rating period
Hospital size and case complexity

Where to Find Hospital Ratings Online

Patients can compare hospital ratings through several free public tools:

Medicare’s Care Compare: Allows users to search for and compare hospitals, doctors, nursing homes, hospice providers, and other Medicare providers
CMS Provider Data Catalog: Offers downloadable CMS datasets for users who want to review hospital quality measures in more detail
Leapfrog Hospital Safety Grade: Allows users to search by city, state, hospital name, or location to find a hospital’s current safety grade

Using more than one tool can give patients a broader view of hospital performance, especially when comparing overall quality ratings with safety-focused grades.

Hospital Ratings in the Northeast

For patients in states such as Connecticut, Massachusetts, Rhode Island, New York, New Jersey, New Hampshire, Vermont, and Maine, these ratings can provide valuable insight when choosing where to receive care. Hospitals throughout the Northeast frequently appear in national quality and safety rankings, though performance can vary significantly even among facilities within the same healthcare system.

Whether you’re researching a future procedure or facing a more immediate healthcare decision, it is important to look beyond the overall grade and review the measures most relevant to your situation. A hospital that excels in one area of care may not necessarily receive the highest marks in every category. Using both quality-focused ratings and safety-focused grades can provide a more complete picture of hospital performance.

How Has Hospital Quality Reporting Evolved?

Hospital quality reporting has changed dramatically over the past two decades. Patients once had limited information about hospital performance and often relied on referrals, reputation, or personal recommendations when making healthcare decisions. Today, organizations such as CMS and The Leapfrog Group make large amounts of hospital performance data available to the public, giving patients access to information that was once difficult to find. This also motivates hospitals to monitor and improve their performance.

Hospital ratings are best viewed as one piece of the decision-making process. When you combine ratings with your conversations with your healthcare providers and an understanding of your own medical needs, they can provide valuable context when choosing where to receive care.

Hospital quality reporting has made it easier for patients to access information that was once difficult to find, but the best healthcare decisions are based on more than a score alone. Understanding what these ratings measure can help you compare hospitals more confidently and ask better questions about your care.