# Hospital Quality Rankings: The Best and Worst States for Hospital Care *CMS star rating data reveals a 2-star gap between top and bottom states, with VA and non-profit hospitals outperforming for-profit facilities by wide margins.* Source: https://ourhealthnetwork.com/insights/hospital-quality-rankings-by-state Author: OurHealthNetwork Editorial Team Published: 2026-03-26 Last updated: 2026-03-26 Reading time: 8 minutes ## Summary Analysis of CMS star ratings for 5,426 U.S. hospitals shows the Mountain West and Upper Midwest consistently outperform the South. VA hospitals average 4.20 stars with zero one-star ratings, while for-profit hospitals average just 2.63. ## Only 52.8% of U.S. Hospitals Have a CMS Star Rating. Here Is What the Data Shows About the Ones That Do. The Centers for Medicare and Medicaid Services rates hospitals on a 1-to-5-star scale, condensing dozens of quality measures into a single number. It is the most visible quality metric in American healthcare, printed on hospital websites and cited in board meetings. But fewer than half of the country's 5,426 hospitals earn enough data to receive a rating at all. We analyzed the latest CMS Hospital Compare data to rank every state by average [hospital](/hospital) star rating, identify where high-quality care clusters, and uncover the ownership and operational patterns that separate top-performing hospitals from the rest. The results show a country where geography, funding model, and hospital ownership predict quality more reliably than most patients realize. 5,426 Total U.S. Hospitals 3.08 Avg Star Rating 288 Five-Star Hospitals 82.9% Have Emergency Services ## The Rating Distribution: A Bell Curve with a Thin Top Of the 2,866 hospitals that carry a star rating, the distribution forms a clear bell curve centered just above 3 stars. One in three rated hospitals (32.6%) lands at exactly 3 stars. The 4-star tier holds 26.7% of hospitals, while the 2-star group captures 22.6%. At the extremes, only 10% of rated hospitals reach 5 stars and 8% sit at 1 star. That means roughly 1 in 10 rated hospitals earns the highest distinction from CMS. For patients searching [doctors and hospitals](/find-doctors) by quality, the 5-star label carries real weight precisely because so few hospitals achieve it. But the geographic distribution of those 288 five-star hospitals is far from even. ## State Rankings: The Mountain West Dominates The top-performing states form a geographic band stretching from the Northern Plains through the Mountain West. [Utah](/hospital/ut) leads the nation at 4.09 average stars, followed closely by [South Dakota](/hospital/sd) at 4.08. [Colorado](/hospital/co) (3.87), Minnesota (3.80), and Wisconsin (3.77) complete the top five. Montana (3.63) and Idaho (3.59) reinforce the regional pattern. At the bottom, the picture flips. [Puerto Rico](/hospital/pr) trails at 2.13 average stars. [Washington D.C.](/hospital/dc) (2.29), [New Mexico](/hospital/nm) (2.45), Mississippi (2.49), and New York (2.53) round out the lowest-performing states. Alabama (2.57) and West Virginia (2.63) sit just above them. "The gap between the best and worst states is nearly 2 full stars. A patient in Utah is statistically twice as likely to find a top-rated hospital as a patient in Mississippi." The spread of 1.96 stars between Utah (4.09) and Puerto Rico (2.13) tells a story about hospital funding, staffing, and infrastructure that follows predictable economic lines. States with higher median incomes, stronger insurance markets, and lower uninsured rates tend to cluster at the top. States with higher poverty rates, rural hospital closures, and strained Medicaid systems fall to the bottom. Rank State Avg Stars Rank State Avg Stars 1 Utah 4.09 42 West Virginia 2.63 2 South Dakota 4.08 43 Alabama 2.57 3 Colorado 3.87 44 New York 2.53 4 Minnesota 3.80 45 Mississippi 2.49 5 Wisconsin 3.77 46 New Mexico 2.45 6 Montana 3.63 47 D.C. 2.29 7 Idaho 3.59 48 Puerto Rico 2.13 ## The Full Picture: All States Ranked by Average Hospital Rating Average CMS Star Rating by State National average: 3.08 stars (dashed line) | Top 15 and Bottom 15 shown 1.5 2.5 3.5 4.5 3.08 avg width = (4.09-1.5)/3.0*490 = 422.8 --> Utah 4.09 width = (4.08-1.5)/3.0*490 = 421.1 --> South Dakota 4.08 width = (3.87-1.5)/3.0*490 = 386.9 --> Colorado 3.87 width = (3.80-1.5)/3.0*490 = 375.7 --> Minnesota 3.80 width = (3.77-1.5)/3.0*490 = 370.8 --> Wisconsin 3.77 width = (3.63-1.5)/3.0*490 = 347.9 --> Montana 3.63 width = (3.59-1.5)/3.0*490 = 341.4 --> Idaho 3.59 width = (3.55-1.5)/3.0*490 = 334.8 --> Nebraska 3.55 width = (3.50-1.5)/3.0*490 = 326.7 --> North Dakota 3.50 width = (3.47-1.5)/3.0*490 = 321.8 --> Maine 3.47 width = (3.45-1.5)/3.0*490 = 318.5 --> Iowa 3.45 width = (3.43-1.5)/3.0*490 = 315.2 --> Oregon 3.43 width = (3.40-1.5)/3.0*490 = 310.3 --> Kansas 3.40 width = (3.38-1.5)/3.0*490 = 307.1 --> New Hampshire 3.38 width = (3.35-1.5)/3.0*490 = 302.2 --> Virginia 3.35 Bottom 15 states width = (2.83-1.5)/3.0*490 = 217.3 --> Arkansas 2.83 width = (2.82-1.5)/3.0*490 = 215.6 --> Connecticut 2.82 width = (2.80-1.5)/3.0*490 = 212.3 --> Nevada 2.80 width = (2.79-1.5)/3.0*490 = 210.7 --> Louisiana 2.79 width = (2.78-1.5)/3.0*490 = 209.1 --> Maryland 2.78 width = (2.75-1.5)/3.0*490 = 204.2 --> South Carolina 2.75 width = (2.73-1.5)/3.0*490 = 200.9 --> Tennessee 2.73 width = (2.63-1.5)/3.0*490 = 184.4 --> West Virginia 2.63 width = (2.57-1.5)/3.0*490 = 174.6 --> Alabama 2.57 width = (2.53-1.5)/3.0*490 = 168.2 --> New York 2.53 width = (2.49-1.5)/3.0*490 = 161.7 --> Mississippi 2.49 width = (2.45-1.5)/3.0*490 = 155.2 --> New Mexico 2.45 width = (2.29-1.5)/3.0*490 = 129.0 --> D.C. 2.29 width = (2.13-1.5)/3.0*490 = 102.9 --> Puerto Rico 2.13 ## Where the Five-Star Hospitals Are California leads the nation with 25 five-star hospitals, followed by Texas with 22. Ohio and Pennsylvania tie at 15 each, and Wisconsin punches well above its population weight with 13. These raw counts partly reflect state size, but the concentration patterns matter more than the totals. Wisconsin's 13 five-star hospitals from a relatively small population base help explain its 3.77 average. Texas, with 22 five-star hospitals but also dozens of low-rated facilities spread across rural areas, lands in the middle of the pack overall. The lesson: a state can have many excellent hospitals and still post a mediocre average if its lower-tier facilities drag down the mean. ## The Best Hospital Cities in America Among cities with at least three rated hospitals, Denton, Texas, leads at 4.67 average stars. Grand Junction, Colorado, and Aurora, Colorado, tie at 4.33. Fargo, North Dakota, also hits 4.33, giving the Northern Plains and Mountain West another top mark. The more telling comparison looks at large metros. San Diego posts a 4.20 average, making it the top-rated major city in the dataset. Boston follows at 4.17, reflecting the concentration of teaching hospitals and research centers in the city. Cleveland (4.00) and Salt Lake City (4.00) both match the 4-star threshold. These four cities share a pattern: strong academic medical centers, multiple competing health systems, and patient populations with above-average insurance coverage. ## The VA Advantage: Government Hospitals Outperform Everyone The single most striking finding in this dataset is the performance of Veterans Affairs hospitals. VA facilities average 4.20 stars, more than a full star above the national average of 3.08. They produced 55 five-star hospitals and zero one-star hospitals. That means 19.1% of all five-star hospitals in the country are run by the VA. 4.20 VA Hospital Average 55 five-star, 0 one-star 2.63 For-Profit Average 3.2:1 one-star-to-five-star ratio These numbers challenge decades of public criticism of the VA system. While access problems and wait times have generated headlines, the quality measures that CMS tracks tell a different story. VA hospitals operate under a single integrated system with standardized protocols, electronic health records, and patient populations that return for ongoing care. That continuity appears to translate directly into better outcomes on mortality, readmission, and patient safety metrics. ## Ownership Matters: The Non-Profit vs. For-Profit Gap Beyond the VA, the ownership structure of a hospital is one of the strongest predictors of its star rating. Non-profit hospitals average 3.18 stars. For-profit hospitals average 2.63 stars. That 0.55-star gap is statistically significant across thousands of facilities. 0.55 Stars Quality Gap Between Non-Profit and For-Profit Hospitals Non-profit: 3.18 avg | For-profit: 2.63 avg For-profit hospitals carry a 3.2-to-1 ratio of one-star to five-star ratings. That means for every for-profit hospital earning the highest CMS rating, more than three receive the lowest. The pattern holds across regions and hospital sizes. It shows up most clearly in safety and readmission measures, where for-profit facilities consistently underperform their non-profit counterparts. The reasons are structural. For-profit hospitals face pressure to generate returns for investors, which can lead to thinner staffing ratios, shorter average lengths of stay, and less investment in the quality infrastructure that drives CMS scores. Non-profit hospitals reinvest surplus revenue into facilities, staff, and patient care programs. That financial model tends to produce better outcomes on the exact measures CMS uses to assign star ratings. ## How CMS Calculates Hospital Star Ratings The CMS star rating system uses five measure groups, each weighted to produce a single overall score. Understanding the methodology helps explain why certain hospitals score well and others do not. Mortality measures (22% of the total score) track 30-day death rates for conditions like heart attacks, heart failure, pneumonia, and COPD. Safety of care (22%) covers hospital-acquired infections, falls, and surgical complications. Readmission rates (22%) measure how often patients return to the hospital within 30 days of discharge. Patient experience (22%) draws from HCAHPS survey responses on communication, pain management, and discharge instructions. Timely and effective care (12%) looks at metrics like door-to-balloon time for heart attack patients and flu vaccination rates for staff. Starting in 2026, CMS introduced a significant change: hospitals in the lowest quartile for safety measures are now capped at 4 stars regardless of their performance on other measures. This "safety cap" means a hospital cannot reach 5 stars if its infection rates or complication rates are among the worst 25% nationally. The change reflects a growing consensus that patient safety should function as a floor, not just one factor among many. For more details on the methodology, see the [CMS Hospital Star Ratings fact sheet](https://www.cms.gov/medicare/quality/hospital-compare-overall-star-ratings). ## What This Means for Patients Star ratings are a starting point, not a final answer. A 5-star hospital in rural South Dakota may not offer the specialized surgical program a patient needs. A 2-star hospital in New York City may house world-class specialists in specific departments that the star system does not capture at a granular level. The [Leapfrog Hospital Safety Grades](https://www.leapfroggroup.org/ratings-reports/hospital-safety-grade) provide a complementary view focused specifically on patient safety, and using both tools together gives a more complete picture. But the broad patterns in this data are hard to ignore. If you live in the Mountain West or Upper Midwest, your local hospitals are statistically likely to score well. If you live in the Deep South or Mid-Atlantic, the odds shift in the other direction. And if you have a choice between a non-profit and a for-profit facility for the same procedure, the data suggests the non-profit will, on average, deliver better outcomes on the measures CMS tracks. The 47.2% of hospitals that lack a star rating entirely present their own challenge. Many of these are [long-term care facilities](/nursing-home), critical access hospitals, or specialty facilities that do not report enough data to qualify. Patients in areas served primarily by unrated hospitals have less information to work with, which makes independent research through tools like [OurHealthNetwork's hospital search](/hospital) even more important. ## The Bottom Line Hospital quality in America is not randomly distributed. It follows clear patterns shaped by geography, ownership, and funding. The Mountain West and Upper Midwest consistently outperform the South and Mid-Atlantic. Non-profit and VA hospitals outperform their for-profit counterparts by wide margins. And the new CMS safety cap will likely push some hospitals to address infection and complication rates that have been masked by strong scores in other categories. For patients, the takeaway is straightforward: check the rating before you check in. The star system is imperfect, but a 2-star gap between two hospitals in your area is not noise. It reflects real differences in how often patients survive, how often they come back, and how safe they are during their stay. ## Tags hospital ratings, hospital quality, CMS star ratings, hospital rankings by state, healthcare quality ## Related articles on OurHealthNetwork - https://ourhealthnetwork.com/insights/medicare-desert-map-cities-worst-acceptance - https://ourhealthnetwork.com/insights/telehealth-adoption-by-state - https://ourhealthnetwork.com/insights/gender-gap-medicine-specialties ## About this article This article is part of OurHealthNetwork's insights collection. We are an independent healthcare data platform aggregating federal datasets (CMS, FDA, CDC) to inform patients and caregivers. See https://ourhealthnetwork.com/methodology for our editorial approach and https://ourhealthnetwork.com/data-sources for source datasets.