Star Rating Calculation

The hospice star rating on Medicare's Care Compare is the CAHPS Hospice Survey Star Rating, a one-to-five-star summary of family caregiver experience called the Family Caregiver Survey Rating (CAHPS Hospice Star Ratings Technical Notes, August and November 2025 reporting periods, https://www.hospicecahpssurvey.org/globalassets/hospice-cahps4/public-reporting/star-ratings/cahps-hospice-star-ratings-technical-notes-august-november-2025-reporting-periods-final.pdf). It is derived only from survey data; there is no separate clinical-outcome star rating for hospices.

CMS calculates nine CAHPS Hospice Star Ratings: one for each of the publicly reported CAHPS Hospice measures and the summary Family Caregiver Survey Rating that combines them (CAHPS Hospice Star Ratings FAQs)^[1]. Survey responses are converted to top-box scores, adjusted for case mix and survey mode, and then translated into stars using a clustering method: distances between hospice scores are measured by Euclidean distance, Ward's minimum variance method groups hospices, and five clusters are cut from the resulting tree to assign one through five stars (CAHPS Hospice Star Ratings Technical Notes)^[2]. The summary rating is publicly reported only for hospices with 75 or more completed surveys over the reporting period. Ratings are built on a rolling eight quarters of survey data and updated every other quarter, roughly every six months. Because assignment is cluster-based, stars are relative to the national distribution of hospices in that period rather than fixed to absolute score cutoffs.

Two features of the methodology have direct operational consequences. First, the star is relative: because clustering ranks hospices against peers, a hospice can raise its raw caregiver-experience scores and still lose a star if the national field improves faster, making the competitive position of a hospice's scores as significant as the scores themselves. Second, the 75-completed-survey floor means smaller hospices may not display a summary star at all, creating a reporting gap that referral sources checking Care Compare will notice. Hospice has no clinical-outcome or claims-based star like the skilled nursing five-star system, so this single caregiver-experience rating carries the entire public-facing quality reputation of a hospice program, and weak results from a given period remain in the rolling eight-quarter calculation for approximately two years.