Hospital ratings can tell you a lot. But here are the follow-up questions you could ask to learn more.
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Making a decision about hospital care is one of the most critical choices for a patient or their family, often made under significant time constraints. Hospital ratings are designed to assist with this decision. The Forbes Top Hospitals By State 2026 ratings are based on 56 quality measures sourced from federal data, including outcomes like mortality, infections, and readmissions, as well as evidence-based practices, value, and patient experience from surveys. These are all adjusted for the social health determinants in each hospital’s community.
This is where measurement drives improvement. Publishing outcomes encourages hospitals to standardize best practices, identify issues earlier, and compete based on results rather than reputation. Within hospitals, this data guides chief quality officers and clinical teams on areas needing focus. For instance, an increase in a complication rate could prompt a review of a unit’s protocols much sooner than it might otherwise be detected.
However, ratings offer a simplified answer to a complex question. Understanding what they actually measure and what a high score does and doesn’t ensure can transform a rating from a mere number into a genuinely useful tool.
Here are five insights hospital ratings can provide, along with follow-up questions to help complete the picture.
1. Hospital Performance on Patient Outcomes
Ratings excel in this area. Mortality, infection rates, and readmissions are derived from claims data of real patients, indicating whether individuals tend to survive, avoid complications, and stay out of the hospital post-discharge. A hospital that maintains strong performance over time is likely doing something systematically well.
Follow-up question: Patients should inquire if this performance is consistent at the level of the specific doctor or service line they will use. Hospital-wide averages include all practitioners, and the variation between individual physicians can be more significant than between hospitals. A notable New England Journal of Medicine study revealed that a surgeon’s case volume strongly predicted operative mortality, with patients of low-volume pancreatic surgeons facing significantly higher odds of mortality.
Even top-rated hospitals may excel in some areas like cardiology but underperform in others like obstetrics, as acknowledged by the Forbes hospital list FAQ. Patients should ask how many procedures their surgeon and team perform annually and examine clinical-area details in the hospital’s profile, rather than just relying on the overall score.
2. Adherence to Evidence-Based Best Practices
Process measures evaluate whether a hospital consistently implements known harm-prevention practices, such as timely medication, infection-control protocols, and discharge checklists. These measures reflect how disciplined and well-managed a hospital is.
Follow-up question: Patients should inquire about how their hospital deals with complications. Even excellent hospitals encounter adverse events; the key difference is the ability to quickly detect and respond to deterioration. A significant analysis of Medicare surgical patients indicated similar complication rates between high- and low-mortality hospitals, but the death rate differed once complications occurred, a phenomenon known as “failure to rescue.”
A JAMA Open Network study published in 2026 reaffirms this pattern, indicating hospital performance accounts for numerous preventable deaths in the studied sample. This data isn’t usually included in public ratings, so it’s crucial to ask if there is a dedicated rapid-response team and how quickly higher-level care can be accessed if needed.
3. Patient Communication and Overall Experience
Patient experience surveys gather feedback from real patients on whether nurses and doctors communicated effectively, pain management, and room conditions. This is valuable information for prospective patients.
Follow-up question: Patients should consider how the specific unit they’ll be in manages situations not reflected in survey averages. Aggregate scores won’t reveal if a doctor will patiently explain a difficult diagnosis or if family questions will be welcomed during a crisis. The entire hospital shouldn’t be judged by a single anecdote, whether positive or negative.
If communication is a priority, patients should ask about family meetings, the availability of a palliative or supportive-care team, and how to reach the care team with questions later.
4. Efficient Use of Healthcare Resources
The value measure reflects Medicare spending per patient, adjusted for patient illness severity, indicating whether a hospital achieves good outcomes without unnecessary resource use. It indirectly checks for overuse.
Follow-up question: Patients should ask about actual billing, as this differs from value scores. Facility fees, out-of-network charges, aggressive collections, and financial assistance policies vary widely among hospitals and aren’t reflected in the value score. A KFF analysis estimates Americans owe at least $220 billion in medical debt, with one in twelve adults carrying some debt.
Before a planned procedure, patients should confirm with their insurer whether the hospital and all involved physicians are in-network and directly inquire about financial assistance policies. A 5-star hospital can still result in significant financial burdens, which ratings won’t indicate.
5. Timeliness and Accessibility of Care
Ratings do include some measures of timeliness, such as the percentage of emergency department patients leaving before being seen, providing a narrow glimpse into whether the hospital is adequately staffed for demand.
Follow-up question: Ratings don’t cover several timeliness aspects. No score indicates how long you’ll wait for a specialist appointment or if the emergency department is boarding admitted patients in hallways due to bed shortages. These practical issues matter significantly for many families.
The solution is simple: call ahead to ask about appointment wait times after discharge and how the hospital handles emergency department boarding.
Another consideration is that most measures reflect care from one to three years ago, as ratings rely on Medicare claims that require time to finalize, audit, and aggregate across hospitals. Recent additions or losses of a top team may not be reflected immediately. Therefore, examine trends over multiple years and inquire directly about recent changes to the team or service line you plan to use.
While this isn’t an argument against using ratings, it suggests treating them as one piece of information, similar to a single lab result, interpreted in context alongside questions no database can answer.
For planned care, such as elective surgery, a scheduled delivery, or a complex procedure, use the ratings to create a shortlist, then ask follow-up questions about specific services and areas of interest.
In a true emergency, bypass all these considerations and proceed to the nearest emergency department. In urgent situations, immediate care takes precedence over ratings, and federal law ensures you will be evaluated and stabilized wherever you go.
