The CMS Five-Star Quality Ratingscores a facility from one to five stars on Medicare’s Care Compare so the public can compare quality at a glance. Five stars is much-above-average; one is much-below-average. CMS rates 14,699 Medicare-certified nursing homes — plus home health, dialysis, and hospitals — each on its own measure set.
What the rating is
The Five-Star Quality Rating System began with Nursing Home Compare in 2008 and now appears across several Care Compare settings. It is a relativeranking: CMS sorts facilities against their peers at the snapshot date and assigns stars by where each one falls in the distribution. The point is comparison, not a pass/fail certificate — a facility’s star can move as peers improve or as new inspection and claims data arrive.
How CMS calculates the nursing home rating
For nursing homes, the Overall star is built from three components, each rated on its own:
- Health inspections — findings from the most recent state survey cycles, weighted most heavily. This is the spine of the Overall rating.
- Staffing — nurse hours per resident per day, measured from the mandatory Payroll-Based Journal rather than self-report.
- Quality measures — a set of clinical outcomes drawn from resident assessments and Medicare claims.
CMS starts from the health-inspection star, then adjusts up or down for strong or weak staffing and quality measures to produce the single Overall star most people see first.
Which settings use a star rating
The 1-to-5 scale is shared, but the inputs differ by setting, and not every Care Compare setting carries a single star:
- Nursing homes — Overall + 3 components
- Home health agencies — quality-of-patient-care stars
- Dialysis facilities — clinical-outcome stars
- Hospitals — overall hospital star
- Hospices — family-experience and care-index measures
- Ambulatory surgical centers — ASC-1 to ASC-12 measures
- Inpatient rehab facilities — measure-level reporting
- Long-term acute-care hospitals — measure-level reporting
What each star means
CMS labels the bands in plain terms: 5 stars is much-above-average, 4 above-average, 3 average, 2 below-average, and 1 much-below-average. Because the bands are set against the peer distribution, the same measure value can earn a different star in a different setting or year. Read the components alongside the headline star.
What the star rating does not show
A single star compresses a lot. It will not tell you whether a facility was recently cited for serious harm, how its staffing compares on a specific shift, who owns it, or whether any affiliated individual appears on a federal exclusion list. Those facts live in separate CMS and OIG files. The honest way to read a rating is as a starting filter, then to open the underlying inspection, staffing, ownership, and enforcement records.
Five-star coverage, by the numbers
Read past the star
Open a facility’s inspection, staffing, and ownership records — each field traced to its CMS source and snapshot date.
Browse facility quality data →Frequently asked questions
- What is the CMS Five-Star Quality Rating?
- It is the 1-to-5-star score the Centers for Medicare & Medicaid Services publishes on Care Compare so the public can compare facility quality at a glance. Five stars is much-above-average; one star is much-below-average. CMS publishes a star rating for 14,699 Medicare-certified nursing homes and for thousands of other facilities.
- How does CMS calculate the nursing home star rating?
- The nursing home Overall rating combines three component ratings: health inspections from the most recent state surveys, staffing measured by the Payroll-Based Journal, and a set of quality measures drawn from assessment and claims data. The health-inspection domain carries the most weight; staffing and quality measures adjust the score up or down from there.
- Which facility types get a CMS star rating?
- Nursing homes, home health agencies, dialysis facilities, and hospitals each carry a five-star rating on Care Compare. Hospices, ambulatory surgical centers, inpatient rehabilitation facilities, and long-term acute-care hospitals are measured by other quality indicators — CMS does not assign them a single five-star score.
- Is a 5-star facility always better than a 3-star facility?
- Not necessarily for your specific need. The star rating is a relative ranking against other facilities at the snapshot date, and a high overall rating can mask a weak component — strong staffing but a poor recent inspection, for example. CMS recommends reading the component ratings and inspection records, not only the headline star.
- How often does CMS update the star ratings?
- CMS refreshes the underlying Care Compare files on a recurring schedule — inspections and staffing update through the year, and the composite ratings recalculate with them. Each figure here is read from the CMS file at the snapshot date shown, with the source release date recorded in the Fonteum provenance chain.
- Where can I see the star rating for a specific facility?
- Every facility's rating, component scores, and inspection history are on Care Compare and mirrored on Fonteum's facility pages with the source and snapshot date on each field. You can browse by facility type and state to find an individual nursing home, home health agency, dialysis center, or hospital.
- Do home health and dialysis use the same star method as nursing homes?
- No. Each setting has its own measure set. Home health stars rest mainly on quality-of-patient-care measures across 7,961 rated agencies; dialysis stars rank 7,072 rated facilities on clinical outcomes; hospital stars summarize measure groups across 2,866 rated hospitals. The 1-to-5 scale is shared, but the inputs differ by setting.
Related
- What is CMS Care Compare? — the tool the star ratings live in, and every setting it covers.
- Nursing home staffing levels — the Payroll-Based Journal that feeds the staffing star.
- What is a Special Focus Facility? — the program that flags the worst-performing nursing homes.
- Nursing home quality & ownership data — per-facility ratings, staffing, and inspection records.
- What is a skilled nursing facility? — the setting where the star rating began.
- Nursing home stars vs. actual harm — where the star rating and the deficiency record diverge.