The healthcare quality landscape continues to evolve as CMS places greater emphasis on clinical outcomes, care transitions, and patient experience. Three recent industry developments highlight important trends that hospitals, health systems, and Medicare Advantage organizations should be watching closely as they prepare for future Star Ratings performance.
CMS star ratings are becoming more clinically focused
Beginning with the 2027 Star Ratings program, the U.S. Centers for Medicare and Medicaid Services (CMS) is shifting its measurement strategy from administrative processes to clinical quality, outcomes, and care coordination.
Several measures are being added, including functional status assessments and medication-related safety measures. Others, such as Medication Reconciliation Post-Discharge and certain administrative measures, are being retired. The overarching message is clear: organizations will need stronger clinical documentation, better data capture, and greater focus on patient outcomes to remain competitive.
For healthcare organizations, this means ensuring that clinical data is accurate, timely, and actionable. Success in future Star Ratings will increasingly depend on an organization’s ability to identify care gaps, support preventive care, and measure performance consistently across increasingly complex care environments.
More hospitals are achieving top CMS ratings
CMS recently updated its Overall Hospital Quality Star Ratings, and the results show encouraging progress across the industry. According to CMS data, 385 hospitals received a five-star rating in 2026, representing approximately 12% of rated hospitals. Most hospitals fell into the three- and four-star categories, while only 6.4% received a one-star rating.
Hospital Star Ratings are calculated using measures related to mortality, safety, readmissions, patient experience, and timely and effective care. The increase in five-star hospitals demonstrates that high-quality performance is achievable. At the same time, it raises the bar for organizations seeking to differentiate themselves in an increasingly transparent healthcare environment.
As the performance gap between average and high-performing organizations narrows, success depends on identifying improvement opportunities, monitoring performance trends, and responding quickly when issues emerge.
Why the first 24 hours after discharge matter
Perhaps one of the most actionable insights comes from the growing focus on transitions of care. The period immediately following hospital discharge has a significant impact on multiple Star Ratings measures, including medication reconciliation, follow-up appointments, readmission prevention, and patient experience. Some of these measures have performance windows as short as seven days, making rapid intervention critical.
Leading organizations are moving away from managing quality measures as separate initiatives and instead focusing on the patient’s overall transition journey. With real-time visibility into discharge events, care teams can proactively address medication changes and barriers to recovery, schedule follow-up visits, and reduce the likelihood of avoidable readmissions.
Data readiness is becoming a strategic imperative
As quality programs evolve, healthcare leaders should look beyond measure specifications and workflows alone.
Organizations frequently focus on reporting requirements after measures have been finalized. However, many quality challenges originate earlier in the process, when clinical information is captured, coded, exchanged, and used across systems.
Incomplete, inconsistent, or difficult-to-use clinical data can make it harder to spot unmet care needs, measure performance consistently, and gain a complete view of patient populations.
As healthcare organizations expand interoperability, value-based care, and population health programs, strong data governance becomes increasingly important. Standardization, ongoing maintenance, and proactive data quality management can create a foundation for quality improvement efforts across the enterprise.
The question is no longer:
“Are we prepared for future Star Ratings requirements?”
Rather, healthcare leaders should ask:
“Can we trust the data we’re using to measure them?”
Actionable takeaways for clinical leaders
As CMS continues to evolve Star Ratings, clinical leaders have an opportunity to strengthen their approach. Here are five areas to prioritize:
1. Audit your clinical data strategy
Evaluate whether clinical documentation, coding workflows, and reporting processes accurately capture patient conditions, interventions, and outcomes.
Action steps:
- Review quality measures impacted by recent CMS changes
- Assess data integrity across EHR, quality, and analytics platforms
- Pinpoint missing documentation that may affect quality reporting
- Create dashboards for real-time visibility into performance trends
2. Prioritize care transition programs
Organizations that treat discharge as a coordinated workflow rather than a series of disconnected tasks can act more quickly during critical transition periods.
Action steps:
- Establish alerts for hospital admissions and discharges
- Standardize outreach within 24 hours of discharge
- Integrate medication reconciliation, follow-up scheduling, and patient education into a single workflow
- Monitor transition-of-care metrics weekly rather than monthly
3. Strengthen cross-continuum collaboration
High-performing organizations align acute care, ambulatory care, case management, pharmacy, and payer teams around shared quality goals rather than siloed measures.
Action steps:
- Develop multidisciplinary transition-of-care teams
- Create shared accountability for readmissions and follow-up care
- Use standardized communication tools across care settings
- Incorporate social determinants of health and barriers to care into discharge planning
4. Focus on preventing readmissions before they occur
Organizations that proactively identify at-risk patients before discharge can intervene before preventable issues lead to another hospital stay.
Action steps:
- Use risk stratification tools to detect high-risk patients
- Implement discharge planning earlier in the care journey
- Monitor follow-up appointment completion and medication adherence
- Track readmission trends to reveal opportunities for intervention
5. Establish ongoing data governance
Build ongoing processes to flag and address clinical data issues before they affect quality measurement and reporting.
Action steps:
- Monitor data quality across clinical and reporting systems
- Establish processes for resolving documentation, coding, and terminology gaps
- Evaluate whether quality teams can determine data issues before reporting cycles begin
- Establish ongoing governance processes to support evolving quality and regulatory requirements
Strengthen your clinical data foundation
A stronger clinical data foundation can help organizations put these strategies into practice.
