Grade D, Below Average

D-grade hospitals score 35 to 49 — payments tend to run above-average relative to reported quality measures. Lower aggregate scores can reflect higher-acuity case mix or specific quality domains pulling down the composite.

These hospitals score 35-49 on the Value Score; payments tend to run above-average relative to reported quality measures. The Value Score is editorial — built on top of public Medicare payment data and CMS Hospital Compare quality measures — and it is a starting reference, not a clinical recommendation. CMS Hospital Compare publishes its own federal star rating that is independent of price.

Average payments in the Grade D cohort sits well above the national Medicare payment baseline — about 32% over the national average. The top reimbursement tier typically pulls in academic centers, large urban referral hospitals, and facilities with high-acuity case mixes that lift average DRG weights.

Within the cohort, hospital-to-hospital variation reflects regional Medicare wage indexes, case mix, teaching status, and outlier-payment adjustments — the same drivers that move pricing across every CMS DRG. 679 hospitals fall under Grade D hospitals, a sample large enough that aggregate statistics are stable and broadly representative of the segment.

For non-Medicare patients, the more relevant figure than the Medicare average is the negotiated commercial rate or cash-pay rate, published by every hospital under the CMS Hospital Price Transparency Rule.

Average CMS Hospital Compare star rating across the Grade D cohort is 1.8, with 192 hospitals carrying a 2-star rating. CMS publishes the underlying mortality, readmission, safety, infection, and patient-experience domain measures alongside the composite — useful when a Value Score grade does not match expectations from the headline star rating.

For deeper clinical context, the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators and Inpatient Quality Indicators feed many of these CMS measures and are useful for comparing acute-care facilities directly.