Question 1

What is a Value Score?

Accepted Answer

The Value Score is our proprietary grading system that rates hospitals from A (best value) to F (worst value) by combining three factors: price relative to the national average for the same procedures (40%), CMS overall quality star rating (40%), and patient outcome measures including mortality, safety of care, and readmission rates (20%). A hospital can charge above-average prices and still earn a good Value Score if its quality and outcomes are exceptional. The goal is to identify hospitals where you get the best care relative to what you pay.

Question 2

Where does this data come from?

Accepted Answer

Hospital quality ratings come from CMS Care Compare (Hospital General Information), which publishes star ratings based on over 40 quality measures. Payment data is derived from Medicare IPPS (Inpatient Prospective Payment System) claims data, which records what Medicare actually pays for each hospital stay. Under the Hospital Price Transparency Rule effective since 2021, all U.S. hospitals are legally required to publish their negotiated rates in machine-readable format. We aggregate and standardize this data to enable meaningful comparisons across hospitals.

Question 3

What do the prices represent?

Accepted Answer

The prices shown are average total payments for inpatient hospital stays, classified by DRG (Diagnosis Related Group). Each DRG represents a specific type of procedure or diagnosis. "Total Payment" is the full amount paid to the hospital from all sources combined, while "Medicare Pays" shows the portion covered by Medicare. These are real payment amounts, not list prices or chargemaster rates. Your actual cost will vary based on your insurance plan, whether the hospital is in-network, length of stay, and any complications that arise during treatment.

Question 4

Why do hospital prices vary so much?

Accepted Answer

The same procedure can cost 3 to 10 times more at one hospital than another, even within the same city. This variation exists because hospitals negotiate prices individually with each insurance company, and there is no standardized pricing system in U.S. healthcare. Teaching hospitals and major academic medical centers tend to charge more due to higher overhead, research costs, and specialist availability. Rural and community hospitals often charge less but may have fewer specialty services. Geographic cost of living, local market competition, and hospital ownership (nonprofit vs. for-profit) also drive price differences.

Question 5

What is a DRG (Diagnosis Related Group)?

Accepted Answer

A Diagnosis Related Group (DRG) is Medicare's classification system for hospital inpatient stays. Each DRG groups together patients with similar diagnoses, procedures, and levels of complexity. For example, DRG 470 covers major hip and knee joint replacement without complications. Hospitals receive a fixed payment for each DRG regardless of how long the patient stays or how many resources are used. This system allows meaningful price comparisons because you can compare what different hospitals charge for the exact same type of case.

Question 6

How do CMS star ratings work?

Accepted Answer

CMS assigns each hospital an overall star rating from 1 to 5 stars based on more than 40 quality measures across five categories: mortality, safety of care, readmission, patient experience, and timely and effective care. About 10% of hospitals earn 5 stars, while roughly 5% receive 1 star. These ratings are updated annually and are based on publicly reported data that hospitals are required to submit. A 5-star hospital with average prices would earn a high Value Score, while a 1-star hospital charging premium prices would score poorly, reflecting poor value for patients.

How Much Does It Really Cost?

Hospitals by Value Score

Coast Plaza Hospital

Hudson Regional Hospital

St John's Episcopal Hospital At South Shore

San Dimas Community Hospital

The University Of Vermont Health Network-Alice Hy

Highland Hospital

Carewell Health Medical Center

Garfield Medical Center

Fairchild Medical Center

Adventist Health Bakersfield

Community Regional Medical Center

Memorial Hospital Of Gardena

Rochester General Hospital

Highland Hospital

Baystate Noble Hospital

St Vincent Hospital

Doctors Medical Center

George Washington Univ Hospital

Carepoint Health-Hoboken University Medical Center

St James Hospital

Browse by Procedure

Major Hip and Knee Joint Replacement

Septicemia or Severe Sepsis without Ventilator

Heart Failure and Shock with MCC

Heart Failure and Shock with CC

Intracranial Hemorrhage or Cerebral Infarction with MCC

Simple Pneumonia and Pleurisy with CC

Kidney and Urinary Tract Infections without MCC

Esophagitis, Gastroenteritis with MCC

Percutaneous Cardiovascular Procedure with Drug-Eluting Stent

Spinal Fusion (Non-Cervical) with MCC

Cervical Spinal Fusion without CC/MCC

GI Hemorrhage with MCC

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