HCAHPS Star Ratings

New HCAHPS Technical Assistance Email Address (hcahps@hsag.com)

Quick Links:  HCAHPS Star Ratings Technical Notes | HCAHPS Stars Ratings Distributions | HCAHPS Summary Star Ratings Distributions | HCAHPS Summary Star Distributions by US State | National Provider Call Audio and Presentation Materials | FAQs

HCAHPS Star Ratings Technical Notes

As part of the initiative to add five-star quality ratings to its Compare Web sites, the Centers for Medicare & Medicaid Services (CMS) publishes HCAHPS Star Ratings to the Care Compare Web site. Star Ratings make it easier for consumers to use the information on the Compare Web sites and spotlight excellence in healthcare quality. Eleven HCAHPS Star Ratings will appear on Care Compare: one for each of the 10 publicly reported HCAHPS measures, plus an HCAHPS Summary Star Rating. CMS updates the HCAHPS Star Ratings each quarter.

Please click here to access the October 2021 Star Ratings Technical Notes.

Previous Technical Notes:

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HCAHPS Stars Ratings Distributions

Please click here to see the HCAHPS Stars Ratings Distributions for the October 2020 public reporting.

Previous Stars Ratings Distributions: 

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HCAHPS Summary Star Ratings Distributions (Beginning with April/May 2016, reported above in the HCAHPS Stars Ratings Distributions)

Previous HCAHPS Summary Star Ratings Distributions:

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HCAHPS Summary Star Distributions by US State

Please click here to see the distributions of the HCAHPS Summary Star Ratings by US State in the October 2020 public reporting.

Previous Summary Star Distributions by US State:

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Star Ratings: National Provider Call Audio and Presentation Slides Now Available

To assist consumers in understanding the Star Ratings, the audio and presentation materials from the National Provider Call held on October 8, 2014, are now available. Click on the link below to access the audio and transcript portions of the National Provider Call regarding Star Ratings: http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2014-10-08-HCAHPS-Star-Ratings.html?DLPage=1&DLSort=0&DLSortDir=descending

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Frequently Asked Questions About the HCAHPS Star Ratings


  • What is the purpose of HCAHPS Star Ratings?

    CMS has created the HCAHPS Star Ratings in order to enable consumers to more quickly and easily assess the patient experience of care information that is provided on the Care Compare Web site. Star ratings, which CMS plans to roll-out on other Compare Web sites as well, will also allow consumers to more easily compare hospitals.

  • What is the purpose of HCAHPS Star Ratings when measure scores are already reported?

    HCAHPS Star Ratings will provide a quick summary of each HCAHPS measure in a format that is increasingly familiar to consumers.

  • Do HCAHPS Star Ratings provide all the information needed to choose a hospital?

    Consumers should consider multiple factors when choosing a hospital. Other data that are publicly reported on Care Compare can be very useful. The new HCAHPS Star Ratings summarize one aspect of hospital quality: patients’ experience of care. In addition, consumers should discuss hospital quality with their healthcare professionals when selecting a hospital.

  • When HCAHPS Star Ratings are added to Care Compare, will any of the information on HCAHPS be removed from the Web site?

    No. All of the HCAHPS information currently displayed on Care Compare Web site and the downloadable database will continue to be available when the HCAHPS Star Ratings are added to the Web site.

  • How often will HCAHPS Star Ratings be updated?

    CMS plans to update HCAHPS Star Ratings quarterly. HCAHPS Star Ratings are based on the same data that are used to create the HCAHPS measures publicly reported on the Care Compare Web site. The first public reporting of the HCAHPS Star Ratings in April 2015 will be based on patients discharged between July 1, 2013 and June 30, 2014. HCAHPS Star Ratings, including the Star Ratings level thresholds, will be recalculated for each public reporting.

  • Where does the HCAHPS data come from for Star Ratings?

    The HCAHPS Survey of hospital inpatients is the source of information for the HCAHPS Star Ratings and the HCAHPS measures publicly reported on Care Compare. See the HCAHPS Fact Sheet available at https://hcahpsonline.org/en/facts/ for more information on the HCAHPS Survey.

  • When will hospitals first see their HCAHPS Star Ratings?

    Hospitals will have the opportunity to see their HCAHPS Star Ratings in their official CMS Preview Report for each reporting period. Hospitals will first see their Star Ratings in the December 2014 Preview Report. This will be a “dry run” in that these HCAHPS Star Ratings will not be publicly reported in December 2014. HCAHPS Star Ratings will be publicly reported for the first time in April 2015.

Hospital Eligibility

  • Which hospitals are included in HCAHPS Star Ratings?

    All hospitals that participate in the HCAHPS Survey are eligible to receive HCAHPS Star Ratings; this includes both Inpatient Prospective Payment System (IPPS) hospitals and Critical Access Hospitals (CAH). IPPS hospitals are required to report HCAHPS as part of the Inpatient Quality Reporting program and CAHs voluntarily participate.

    Additionally, hospitals must have at least 100 completed surveys in a 12-month reporting period to be eligible for HCAHPS Star Ratings.

  • Why is it necessary to have at least 100 completed surveys to receive HCAHPS Star Ratings?

    HCAHPS scores based on fewer than 100 completed surveys do not have the required statistical reliability for HCAHPS performance measurement.

  • Why did our hospital not receive HCAHPS Star Ratings?

    In order to receive HCAHPS Star Ratings a hospital must have at least 100 completed surveys for the reporting period and be eligible to publicly report HCAHPS scores.

HCAHPS Measures that Receive HCAHPS Star Ratings

  • Which HCAHPS measures will receive HCAHPS Star Ratings?

    There is a Star Ratings for each of the following HCAHPS measures:
    • HCAHPS Composites
               — Communication with Nurses (Q1, Q2, Q3)
               — Communication with Doctors (Q5, Q6, Q7)
               — Responsiveness of Hospital Staff (Q4, Q11)
               — Communication about Medicines (Q16, Q17)
               — Discharge Information (Q19, Q20)
               — Care Transition (Q23, Q24, Q25)
    • HCAHPS Individual Items
               — Cleanliness of Hospital Environment (Q8)
               — Quietness of Hospital Environment (Q9)
    • HCAHPS Global Items
               — Overall Hospital Rating (Q21)
               — Recommend the Hospital (Q22)
    In addition, CMS is introducing a roll-up of all of the HCAHPS Star Ratings: the HCAHPS Summary Star Rating.

HCAHPS Summary Star Rating

  • What is the HCAHPS Summary Star Rating?

    The HCAHPS Summary Star Rating combines (rolls-up) all of the HCAHPS Star Ratings. For detailed information and an example of its calculation, please see the Technical Notes for HCAHPS Star Ratings.

  • Why is CMS calculating a roll-up Star Rating for HCAHPS? Isn’t the Overall Rating item that survey respondents provide enough?

    The HCAHPS Summary Star Rating combines all information about specific aspects of patient experience of care. The Overall Hospital Rating measure and its star rating report the responses to a single survey item. CMS believes that each of these indicators is valid and useful for consumers, and consumers have indicated these pieces of information are important for their decision making. Consumers can drill down from the HCAHPS Summary Star Rating and see all of the HCAHPS measures.

Methodology of HCAHPS Star Ratings

  • How are HCAHPS Star Ratings assigned for each measure?

    HCAHPS responses are first converted to linear mean scores and then adjusted for patient mix and mode of survey administration. Next, a clustering algorithm groups hospitals into five star categories for each HCAHPS measure.

    For more details, please see the
    Technical Notes for HCAHPS Star Ratings.

  • Why does the number of hospitals receiving 5 stars differ for each HCAHPS Star Ratings?

    HCAHPS Star Ratings are assigned in a way that minimize differences within groups and maximize differences between star groups. The clustering algorithm empirically determines the number of hospitals in each star rating category independently for each HCAHPS measure. CMS does not force a certain percentage or number of hospitals into a specified Star Rating category.

  • Why are linear mean scores used for the HCAHPS Star Ratings rather than the Top-Box scores that are reported on Care Compare?

    Linear mean scores and Top-Box scores are alternative, statistically valid methods for summarizing HCAHPS performance. Linear mean scores incorporate the full range of survey response categories into a single metric for each HCAHPS measure. “Top-Box” scores, on the other hand, consist of only the most positive response to HCAHPS Survey items. Please note that Care Compare reports top-box, middle-box and bottom-box scores for all HCAHPS measures. See http://www.medicare.gov/care-compare/

    For more information on linear mean scores, please see
    Technical Notes for HCAHPS Star Ratings.

  • If our hospital’s Top-Box scores are higher than the national average, why is our HCAHPS Star Rating not equal to 5?

    Five stars denotes the highest category of hospital performance; not all hospitals with above average Top-Box scores will attain this designation.

HCAHPS Star Ratings and Hospital VBP

  • How do Star Ratings impact our Hospital VBP payment?

    HCAHPS Star Ratings are not used in the Patient Experience of Care Domain of the Hospital VBP program or for the Hospital VBP payment determination.

  • Our hospital performed well in Hospital VBP, so why did we receive only 2 stars in the HCAHPS Summary Star Rating?

    There are several reasons why an above average Hospital VBP score may not result in above average HCAHPS Summary Star Rating. For instance, Hospital VBP recognizes both improvement and consistency in HCAHPS scores, whereas the HCAHPS Star Ratings do not.

  • Do HCAHPS Star Ratings account for improvement?

    No, unlike the Patient Experience of Care Domain scores in the Hospital VBP program, improvement is not a component of the HCAHPS Star Ratings.

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This page was last modified on (8/3/21)