One star rating. Ten-plus reporting programs. Three payment adjustments.
CMS measures hospitals across more programs than any other provider type — covering everything from how often patients die within 30 days of discharge, to whether a nurse communicated clearly, to whether a hospital-acquired infection occurred in the ICU. Most of these programs generate their own public data. Several of them also affect how much Medicare pays the hospital.
The Overall Hospital Star Rating is the most visible output. It summarizes performance across five measure groups into a single 1–5 score. But the star rating is a starting point — it compresses a lot of variation, and the programs behind it are worth understanding individually.
What gets measured — and what each program covers.
Each program below generates its own public dataset on the CMS Provider Data Catalog. Some feed the Overall Star Rating. All of them appear on individual hospital profiles.
30-day mortality rates for major conditions and surgical procedures, plus the PSI-90 composite of serious preventable in-hospital complications. Two of the five star rating groups draw from this program.
Standardized Infection Ratios for CLABSI, CAUTI, surgical site infections, MRSA bloodstream events, and C. difficile. Reported to the CDC's National Healthcare Safety Network and published quarterly.
The Hospital Consumer Assessment of Healthcare Providers and Systems — a standardized patient survey covering nurse communication, doctor communication, responsiveness, quietness, discharge information, and overall hospital rating.
How consistently hospitals deliver evidence-based care — sepsis bundle adherence, ED throughput times, preventive care rates, and outpatient imaging efficiency. These measures reflect process, not outcome.
30-day unplanned readmission rates and excess days in acute care — by condition (AMI, HF, PN, COPD, hip/knee, CABG, stroke) and hospital-wide. Lower readmission rates feed the star rating and the HRRP payment adjustment.
Episode-based spending during hospitalization and for the 3 days before through 30 days after discharge — risk-standardized and compared to the national median. An efficiency measure, not a quality measure.
Obstetric care quality measures including cesarean delivery rates, severe maternal morbidity, and unexpected complications in term newborns. A relatively new reporting program with growing measure sets.
Three programs that tie quality performance directly to Medicare payment.
Most quality reporting programs generate data but do not change what a hospital gets paid. These three are different — each adjusts a hospital's Medicare reimbursement based on how it performs on a specific set of measures. Together they can shift payment by several percentage points in either direction.
A budget-neutral incentive program that rewards hospitals for performance across clinical outcomes, person and community engagement, safety, and efficiency. High performers receive a bonus; low performers face a reduction — on the same Medicare dollar pool.
Hospitals with excess readmissions for AMI, heart failure, pneumonia, COPD, hip/knee replacement, and CABG face a penalty of up to 3% on all Medicare inpatient payments. Dual-eligibility adjustment introduced in 2019.
The worst-performing quartile on hospital-acquired conditions — a composite of PSI-90 and HAI measures — faces a 1% reduction on all Medicare inpatient payments. The only CMS program where being in the bottom 25% automatically triggers a penalty.
- CMS Hospital Downloadable Database Data Dictionary, January 2026 — CMS Provider Data Catalog
- Overall Hospital Quality Star Ratings Methodology — QualityNet.cms.gov
- Hospital Value-Based Purchasing Program — CMS.gov
- Hospital Readmissions Reduction Program — CMS.gov
- Hospital-Acquired Condition Reduction Program — CMS.gov