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How We Rate Hospitals

Answers to questions about how the hospitals are rated and how you should use the information

Last updated: March 2018

Our hospital ratings help you compare hospitals based on our Safety Score, as well as individual measures relating to patient experience, patient outcomes, and certain hospital practices. Here are some answers to questions you might have about our ratings. (For more details, download our Hospital Ratings Technical Report.)


Click on the map at right to find ratings of hospitals nationwide. The ratings include those hospitals for which we have a safety score, as well as some information on performance for more than 4,000 other hospitals.

1. How do Consumer Reports' hospital ratings differ from information available elsewhere?

Our ratings come from data based on patient experience and outcomes as well as certain hospital practices gathered from public sources. Some of that information is available elsewhere. For example, you can see the federal government's version of scanning and readmissions data on its Hospital Compare website. But collects all the information and summarizes it in an easy-to-interpret format, using our familiar ratings symbols.

2. How can the hospital ratings help me get better care?

They can help you compare hospitals in your area so you can choose the one that's best for you. Even if you don't have a choice of hospitals, our ratings can alert you to particular concerns so you can take steps to prevent problems no matter which hospital you go to. For example, if a hospital scores low in communicating with patients about what to do when they're discharged, you should ask about discharge planning at the hospital you chose and make sure you know what to do when you leave.

3. How can you compare hospitals if patients in some are sicker than those in others?

When possible, our ratings are based on data that have been statistically adjusted to minimize differences among hospitals due to factors that influence the measure result. For example, data for bloodstream infections and catheter-associated urinary tract infection (CAUTI) were adjusted based on where the patients were treated (which intensive-care unit, for example). Scores related to the chance of readmissions and mortality in surgery patients were adjusted based on the health status of patients.

4. Why can't I find my hospital in your ratings?

Our ratings have information on over 4,000 hospitals. If a hospital you're looking for isn't listed, it could be for several reasons. Some report data under a parent organization, so they might not show up as individual facilities. Others may have changed names during the reporting period. And some hospitals, mostly smaller ones, might not have sufficient data for any of our ratings categories.

5. Why doesn't my hospital have a Safety Score?

For a hospital to have a Safety Score, it must have sufficient data for all five composites included in the score: patient experience, readmissions, scanning, infections, and mortality. The data we use come from the Center for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC). If CMS or the CDC does not report data for a measure, it is because the hospital either did not have sufficient data or because there were discrepancies in data collection.

6. What about patient privacy?

Our ratings are comprised of data available to the public from several sources. But none of the information can be used to identify specific individuals.

7. What are some of the limitations of the data used in the ratings?

Unlike most other Consumer Reports ratings, we don't collect the data in our hospital ratings ourselves, so there may be issues with quality we can't control. In some cases the information comes from billing and other administrative data submitted by hospitals to Medicare, and isn't designed to measure patient outcomes. However, we review the methods of data collection, validation, and analysis used by each data provider, and use only the most relevant and best data that are available.

8. What information is included in the ratings?

Our ratings include information on the following.

A. Hospital-acquired Infections. About 650,000 patients each year develop a hospital acquired infection. So, on any given day, about one of every 25 hospitalized patients is infected while in the hospital. The most common types of infections that patients get in the hospital are pneumonia and surgical site infections. About 12 percent of patients die in the hospital from the infections that they get. Hospitals can reduce their rate, to even zero infections in a number of instances, by following evidence-based procedures. We rate hospitals based on their performance on five different hospital-acquired infections. In addition, we have calculated a composite score (“Avoiding Infections Overall”) that combines performance across all five infections listed below:

  • Central-line associated bloodstream infections (CLABSIs). Central lines are catheters, or tubes, used to deliver fluids, medication, and nutrition to patients. Bloodstream infections are caused by a mishandling of those central lines and are the most deadly kind of hospital-acquired infection. Our data come from CMS through Hospital Compare.
  • Surgical-site infections (SSIs). These are surgery-related infections that occur deep in the incision, or in an organ/space as a result of the surgery. They are counted in our ratings if they occur within 30 days of the surgical procedure. All of the states in the U.S. report data on surgical-site infections that occur after the following procedures: colon surgery and abdominal hysterectomy.
  • Catheter-associated urinary tract infections (CAUTIs). These are urinary tract infections that are associated with the patient having an indwelling urinary catheter (tube inserted in the bladder) which are diagnosed based on lab results  and symptoms, or a urinary tract infection without symptoms that are associated with a bloodstream infection.
  • Methicillin-resistant Staphylococcus aureus (MRSA) infections. MRSA is a type of staph bacteria that is resistant to many antibiotics. In a healthcare setting, such as a hospital or nursing home, MRSA can cause severe problems such as bloodstream infections, pneumonia, and surgical site infections. Hospitals must report all MRSA bloodstream infections that start in the hospital and that are identified by lab tests.
  • Clostridium difficile (C. diff.) infections. C. diff. is a common cause of antibiotic-associated diarrhea and, in rare cases, can causes sepsis and death. Antibiotic overprescribing, improper room and equipment cleaning, and poor hand washing in hospitals are the leading causes of infection. Hospitals must report all C. diff. infections that start in the hospital, with the exception of hospital locations with mainly infants.

B. Childbirth. A C-section is the most common form of surgery in the U.S. and about half are thought to be unnecessary, putting both the mother and the baby at risk for medical complications. About 60 percent of hospitals have C-section rates that are higher than the national target of 23.9 percent (the rate of C-sections in first-time moms with low-risk deliveries). Hospitals can reduce their C-section rates by following evidence-based practices such as those published by the California Maternal Quality Care Collaborative (CMQCC).

  • Avoiding C-sections. This information comes from either The Leapfrog Group or the CMQCC. Both groups calculate the percent of low-risk deliveries in first-time mothers—that is, women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned—that occur by cesarean section. The data the ratings are based on do not include information on factors that may increase the risk for a C-section, such as heart problems in the mother or fetus, pregnancy-related high blood pressure, diabetes, obesity, or any other chronic disease.

C. Safety Score. This is a summary of five categories that relate to hospital safety: avoiding infections, avoiding readmissions, communicating about medications and discharge, appropriate use of chest and abdominal scanning, and avoiding mortality (medical and surgical). The score is expressed on 100-point scale. A hospital would score a 100 if it earned the highest possible score in all measures and would score one if it earned the lowest scores in all measures. Each of the five domains is weighted equally. Each is worth 20 points out of 100.

  • Hospital acquired infections. The Safety Score includes a hospital’s performance on a composite (“Avoiding Infections Overall”) of the five hospital-acquired infections described above (see “Hospital-acquired Infections), which are detailed on the “Infections” section for each hospital’s report card page on
  • Communication about new medication and discharge instructions. This is included because lack of communication about drugs can lead to their misuse and other errors. And lack of communication about discharge instructions can lead to errors in post-discharge care.  The ratings are based on data from a survey of millions of patients regarding their experiences during a recent hospital stay (see more below under “Patient Experience”).
  • Readmission to the hospital. Readmissions are tied to patient safety in several important ways. First, any hospital admission has inherent risks, so a second admission exposes the patient to additional risk. Second, readmissions can be caused by something that went wrong during the initial discharge. Finally, readmissions can reflect errors in the initial admission. This rating reflects the chances that a Medicare patient will have to be readmitted to a hospital within 30 days of initial discharge. The information is collected by CMS. Patients can be readmitted to the same or different facility, and for the same or different condition.
  • Mortality. Some 440,000 hospital patients a year die at least in part because of preventable medical errors. Our Safety Score contains two measures of mortality: mortality in patients with  several medical conditions; and mortality in surgery patients.
    • Avoiding death– medical. This rating is based on mortality rates for Medicare patients who died within 30 days of admission for patients who had been hospitalized for heart failure, heart attack, stroke, pneumonia, or chronic obstructive pulmonary disease (COPD).
    • Avoiding death– surgical. This rating is based on data measuring how often Medicare surgical patients died after developing a complication that should have been identified and quickly treated. Complications include pneumonia, a blood clot in a vein deep in the body (deep vein thrombosis) or sudden blockage in a lung artery (pulmonary embolus), potentially fatal bloodstream infection (sepsis), shock/cardiac arrest, gastrointestinal bleeding, or acute ulcer.
  • Appropriate use of scanning. This is included because double scans of the chest and abdomen are rarely necessary and unnecessarily expose patients to additional radiation. This information comes from billing data submitted to CMS that calculates the percent of computed tomography (CT) scans of the abdomen and chest that are performed twice: with and without a dye (or contrast).

D. Heart Surgery. We rate hospitals for heart surgery based on three common procedures: heart bypass surgery, aortic heart valve replacement, and congenital heart surgery. Through a collaboration between Consumer Reports and The Society for Thoracic Surgeons (STS), hospitals can voluntarily report their data to Consumer Reports. Data are reported to STS through their adult and child cardiac registries. The STS measures of survival and complications are adjusted based on the person's risk of these types of events.

  • Heart Bypass Surgery. A hospital’s rating in this measure reflects its performance in isolated heart bypass operations, meaning that the patient is having only that surgery, not a combination procedure. A hospital’s overall score is a composite of four separate measures. Survival: Percentage of patients who are discharged alive and survive at least 30 days after having the surgery. Complications: Percentage of patients who avoid all of the most serious complications, including needing a second operation, developing an infection deep in the chest, suffering a stroke, requiring prolonged ventilation, and experiencing kidney failure. Best surgical technique: Percentage of patients who receive at least one bypass from an internal mammary artery, located under the breastbone, a technique that improves long-term survival. Right drugs: Percentage of patients who receive these medications: beta-blockers before and after surgery to control blood pressure and prevent abnormal heart rhythm; aspirin, to prevent blood clots; and a drug after surgery to lower LDL (bad) cholesterol.
  • Aortic Heart Valve Replacement. A hospital’s score in this measure reflects its performance in isolated surgical aortic valve replacement. A hospital’s overall score is a composite of two separate measures. Survival: Percentage of patients who are discharged alive and survive at least 30 days after having the surgery. Complications: Percentage of patients who avoid all of the most serious complications of the operation, which are the same as for bypass surgery.
  • Congenital Heart Surgery. A hospital’s score reflects the percentage of congenital heart surgery patients that die in the hospital or within 30 days of the surgery.

E. Patient Experience. This information comes from a survey of millions of patients regarding recent hospital stays. The survey, the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, is maintained by CMS. We rate overall patient experience based on the average responses to two survey questions: The percentage of respondents who said they would "definitely" recommend the hospital; and the percentage of respondents who gave the hospital an overall rating of 9 or 10 on a scale of 0 to 10.

In addition, we rate specific measures of patient experience based on answers to questions about:

  • Communication about discharge and medications
  • Doctor-patient and nurse-patient communication
  • Pain control
  • Receiving help when needed
  • Keeping hospital rooms quiet at night and keeping rooms and bathroom clean.

For more details, download our Hospital Ratings Technical Report.

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