Understanding quality scorecards: A primer for boards
Patients and consumers have more information on hospital quality available than ever before. Much of this information comes in the form of scorecards or “report cards” where the complicated hospital environment is evaluated by condensing performance into an easier-to-understand letter grade, star, or ranking. While hospitals have long supported transparency on quality information and the use of quality data in patient decision-making, each scorecard should be considered in full context. Each “grader” makes choices in their grading approach about what good and bad quality of care means, what data sources they use and how they calculate their scores.
Report cards 101
To assist hospital trustees in understanding these report cards and what they may mean for their organizations,, the AHA has compiled a list of some of the most well-known score cards available and a brief assessment of their key characteristics.. Including:
Organization Bio: From government regulators and payers; to non-profit journals; to for-profit, general-interest magazines, the authors of various scorecards differ somewhat in their motivations to publish quality data. Some are looking to promote high-value purchases by consumers (e.g., CMS Star Ratings), while others use proprietary measures to call attention to providers they deem to be socially conscious (e.g., Lown Institute Hospital Index).
Data Source: Many organizations use publicly available data from the Centers for Medicare & Medicaid Services (CMS) quality reporting and value programs. While Medicare is the single largest payer of healthcare services, many CMS measures are calculated on only Medicare patients, providing less insight into the quality of care for non-Medicare patients. Some CMS measures also are not the most meaningful quality metrics. Some organizations collect their own data, usually through surveys filled out by hospitals. These surveys are not always validated to ensure that they collect the intended information, and are often incomplete or missing information.
Scoring Methodology: The scoring methodology describes what areas of a hospital’s performance are evaluated—for example, mortality or infection rates—and how those rates are translated into a resulting score, grade, or ranking. Each report card makes choices about how to reflect complicated measures in an easier to understand way. However, in doing so, some methodologies sacrifice accuracy and specificity. In addition, some methodologies fail to account for factors that influence outcomes but are out of the hospital’s control, like clinical complexity and social drivers of health in their surrounding community.
What’s its focus: A patient might benefit from one type of scorecard more than another based on the type of information it provides. One scorecard might help patients make decisions by offering customized views of hospitals—for example, by state or type of procedure—or by providing more relevant comparisons of like patients or hospitals with certain characteristics.
Caveats: When using hospital scorecards to make decisions, patients should be cautious in assuming a single report gives them all the information they need.
Considerations for Trustees
As outlined above, publicly available report cards come with both strengths and limitations. Boards can help their organizations by asking questions about how the scorecards relate to the hospital’s broader approach to quality and safety improvement, such as:
- How does our organization track our hospital’s quality of care and how is the board included in that process? To what extent do we use public scorecards to inform that work?
- Does our internal data and/or perception of our hospital’s quality match our scores/grades/rankings on public scorecards? Why or why not?
- Are there opportunities for improvement that the scorecards highlight?
- When asked by patients or other members of the public about our report card scores, what can we say about the work we do to improve care that might relate to the measures captured in the scorecards?
Caitlin Gillooley (cgillooley@aha.org) is director, Quality & Behavioral Health Policy, at the American Hospital Association.
© 2026 by the American Hospital Association (www.aha.org). Reprinted with permission.