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385 hospitals get top marks in CMS' 2026 Hospital Star Ratings drop

More hospitals achieved five stars in the CMS 2026 Hospital Star Ratings, despite updates emphasizing the Safety of Care domain.

Sara Heath
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Published: 18 May 2026

The CMS has released its April 2026 Hospital Star Ratings, with more than one-fifth of organizations getting the coveted five-star designation.

That's nearly 100 more hospitals getting a five-star rating since the August 2025 star ratings update.

The CMS Hospital Star Ratings are a tool for healthcare consumers to decide where they might access care. The ratings summarize quality measures across five domains, including mortality rates, safety of care, readmission rates, patient experience and timely and effective care.

In this latest drop, the CMS had quality measures for 4,609 hospitals nationwide. Of those hospitals, 385 (12%) received a five-star rating, up from 291 in August 2025.

Most hospitals received either three or four stars this round, the CMS said, with 991 (30.9%) and 953 (29.8%) receiving each, respectively. Another one-fifth, or 670, organizations received a two-star rating. This represents a drop in the number of hospitals receiving a three-star rating and an increase in those receiving a four-star rating.

Finally, 204 (6.4%) received a one-star rating. That compares to 233 hospitals that received a one-star rating in August 2025.

These scores represent an overall improvement from mid-year 2025. Other quality rating systems have likewise flagged improvements in overall clinical quality, and particularly patient safety.

Star Ratings changes stress patient safety

This latest batch of Hospital Star Ratings reflects methodology updates made as part of the 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center final rule.

Specifically, the final rule introduced changes to the CMS Hospital Star Ratings program that emphasize the Safety of Care domain, which ultimately affects star ratings.

The agency said that, starting in calendar year 2026, there would be a four-star cap on hospitals scoring in the lowest quartile of the Safety of Care measure set. In other words, hospitals in the lowest quartile of this measure set cannot achieve a higher rating than four stars, even if they score perfectly in every other domain.

The Hospital Star Ratings listed above reflect those changes, although the CMS did not provide data about how many hospitals saw their scores drop as a result of poor Safety of Care performance.

Starting in 2027, standards for the Safety of Care domain will rise.

The CMS said any hospital scoring in the lowest quartile for the Safety of Care measure set will see a one-star reduction in its overall score, except for hospitals that would already have been rated one star.

For example, a five-star hospital will automatically be reduced to four stars if it scores in the lowest quartile for Safety of Care, even if it performs perfectly in all other domains.

The CMS said these methodological updates reflect the agency's "commitment to improving health outcomes and advancing patient safety" upon announcing the 2026 OPPS final rule.

The industry didn't take kindly to the changes. America's Essential Hospitals, for example, called for the agency to account for risk adjustment, saying blanket changes could hurt hospitals treating disproportionate shares of high-risk patients.

Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.

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