A new quality assessment of U.S. hospitals by the Centers for Medicare and Medicaid Services gave nearly 58% of Department of Veterans Affairs medical centers the highest four- or five-star ratings — down 9% from 2023.

The VA scores were still significantly higher than private medical centers, only 40% of which earned four or five stars. The department announced Tuesday that its hospitals also outperformed non-VA facilities on patient satisfaction surveys, which gave 79% of VA hospitals four or five stars, compared with 40% of non-VA hospitals.

Despite the drop in overall scores from last year, VA Under Secretary for Health Dr. Shereef Elnahal told reporters Friday that the ratings were “great news” for veterans and the VA employees who treat them.

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“We’re offering more care to more veterans than ever before, and we are exceeding on all metrics, both patient experience metrics and overall hospital quality and patient safety metrics, when we are comparing apples to apples with civilian-sector hospitals,” Elnahal said.

The Centers for Medicare and Medicaid Services, or CMS, examines hospital mortality, safety of care, readmission rates, patient experience, and timeliness and effectiveness of care to award stars on a five-point scale.

This year, 35 VA hospitals earned a five-star quality rating, one more than last year, and 15 of the 35 also earned five stars on CMS’ patient survey ratings.

“Veterans [are] able to see how VA hospitals are comparing to other options they may have in the civilian sector,” Elnahal said. “[If] they have Medicare or private health insurance, they can get care at both options. What this will allow is for them to compare, including — if they qualify for community care, as supported by VA — choices in the civilian sector.”

The new star ratings, which can be found on the Care Compare website, mark the second year the VA was included in the database by CMS, a federal agency within the Department of Health and Human Services. The agency gave star ratings to 109 VA facilities, with the remaining VA hospitals or medical centers not being rated, either because they don’t meet qualification thresholds or the level of metrics needed to assess them.

CMS does not assess specialty hospitals, ambulatory surgical centers, or some inpatient care facilities, such as psychiatric hospitals.

In addition to the 35 VA hospitals that earned five stars, 27 earned four stars, 23 earned three stars, 14 earned two stars and 10 earned one star — up from nine last year but with fluctuations on the one-star list.

Elnahal said the Veterans Health Administration considers these metrics, alongside its internal monitoring systems, when reviewing hospital performance.

“What we do is offer focused attention and support from our headquarters, national improvement office, to those medical centers scoring at the lowest levels on this scale and on our internal scale,” Elnahal said. “What this does is it highlights essentially more medical centers that maybe our internal system isn’t flagging, and ultimately allows us to get an up-to-date picture as more comprehensive of where we are on this.”

The facilities receiving the lowest ratings were the VA Southern Arizona Health Care System in Tucson; Bay Pines VA Health Care System and West Palm Beach VA Medical Center in Florida; Overton Brooks VA Medical Center in Shreveport, Louisiana; VA New Jersey Health Care System; Syracuse VA Medical Center and VA New York Harbor Health Care System in New York; VA Pittsburgh Health Care System; Providence VA Medical Center in Rhode Island; and VA Caribbean Health Care System in San Juan, Puerto Rico.

New to the one-star list were the VA medical centers in Tucson, New Jersey, Syracuse and New York Harbor Health Care. Those that received one star on last year’s list but have since increased their ratings include the James J. Peters VA Medical Center in The Bronx, New York; New Mexico VA Health Care System in Albuquerque; and the Memphis VA Medical Center, Tennessee, all of which are now two-star facilities.

A one-star rating signifies that the facilities performed well below the average for specific measurements, such as death rates for patients with heart failure, surgical complications and pneumonia; readmission rates for certain ailments; hospital-acquired infections; patient satisfaction; and more.

The data for this year’s star ratings was collected between July 2019 and March 2023, according to the VA.

According to CMS, its reviewers rated 4,658 hospitals in the U.S., and of those, just 8% received five stars. Star ratings are “limited in scope,” CMS officials said, by the data sources from which they are derived. 

Among the criticisms of the rankings from advocacy groups and industry associations such as the American Association for Physician Leadership, is that they don’t take into account the socioeconomic status of patients or the surrounding community, which may not have access to routine health care and have worse health outcomes for acute and chronic conditions.

CMS also crunches the numbers in a way that may put smaller facilities or hospitals that have a low number of cases or incidents that meet its eligibility criteria at a disadvantage when it comes to the ratings.

VA officials have noted, however, that surveys of veteran patients not only show positive response to VA services but that trust in VA health care remains high.

“Our most recent outpatient survey results show that 92% of veterans trust the care that they get in our clinics and ambulatory settings, so both inpatient and outpatient trust are at all-time highs, and we are beating the private-sector averages on inpatient trust,” Elnahal said.

In a statement released Tuesday, VA Secretary Denis McDonough said the metrics help the VA convey its message that it provides quality health services.

“We’ve made millions more veterans eligible for VA health care under the PACT Act — and now, we want to make sure that every one of them gets timely access to the world-class care they deserve,” McDonough said. “Whenever a veteran sets foot in a VA facility, we want them to know that they are getting the very best care this nation has to offer — and we won’t ever settle for anything less.”

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