In April 2017, the Centers for Medicare & Medicaid Services (CMS) released their fourth Hospital Quality Star Rating list. Since the first release, stakeholders have been publicly debating the star rating scale's usefulness in comparing hospital quality, but little focus has been given to the large number of rural hospitals with no rating. The brief looks more closely at the characteristics of rural hospitals with and without quality star ratings to help inform ongoing discussions about the usefulness of the quality star rating for comparing hospital quality and possible ways to improve the star rating initiative.

The data in this brief highlight a limitation in using the Hospital Quality Star Rating to compare quality either among rural hospitals or between rural and urban hospitals. More than one third of rural hospitals did not receive a star rating, compared with 12% of urban hospitals. Among rural hospitals, CAHs and very small hospitals (lowest net patient revenue) were least likely to receive a star rating. Rural hospitals without a star rating were clustered across the West, Midwest, and South Census Regions. It is important for consumers, policy makers, and other stakeholders to know that the disproportionate amount of missing data limits the conclusions that can be drawn from comparisons of the rural hospital quality star ratings.