Overview of NRRS

Situation

The CMS Care Compare star recognition program currently requires a minimum of 100 annual inpatient discharges to qualify, excluding over 60% of Critical Access hospitals in the United States. This exclusion stems not only from the low number of qualifying inpatients but also from the program's failure to include swing beds, a core service for rural community hospitals. At present, there is no alternative recognition program specifically designed for rural hospitals.

Purpose

The National Rural Rating System was developed in 2022 to step up and establish credible criteria for a rating system for rural and critical access hospitals, emergency departments, and clinics. Small hospitals still strive to achieve high patient satisfaction scores and improvement with no recognition for these efforts. The goal of this program is to help hospitals achieve greatness, receive recognition for improvements in quality of care and celebrate the successes of hospitals meeting these high standards. With this recognition, rural hospitals will elevate and show respective local communities the quality of care they are providing and become local providers of choice. The standards are based on CMS Care Compare initiative, but altered to accommodate the 100 annual discharge threshold and other metrics.

This initiative is open and welcoming to any and all hospitals with certified survey vendor data.

This rating system will provide patients and visitors with valuable information on these hospitals and clinics similar to CMS. By using calculations from verified actual hospital data and published national benchmarks, NRRS will publish quarterly Star Ratings and an annual National Rural Honor Roll for all registered participants.

Eligibility

Small, rural, and critical access hospitals will register online for inclusion in the program ($250/yr). Data will be submitted quarterly for review through a secure portal. The goal is to use data exports hospitals and clinics are already using for other submissions to CMS and AHRQ or official reports from certified survey vendors. If a hospital does qualify for CMS Care Compare, they are still eligible to participate in NRRS.

For HCAHPS

• Participate in the HCAHPS patient experience rating program
• Utilize an external CMS-certified patient experience vendor
• Report a minimum of 24 HCAHPS survey responses over a rolling 12-month period

For CG Clinical Groups

Coming soon!

For Swing Beds

Coming soon!

Program

Once registered, the platform will collect participant information, logo, contact information, etc. Participants will upload their CMS data or survey vendor reports for specific dates, domains, and scores which are outlined in the dashboard by survey. Upload windows will be published and data received securely via the dashboard. Quarterly the data will be reviewed, scored and published. Annually there will a National Honor Roll announced in Q4 that will be announced at a national event and publicized. Hospitals that score a 4 or 5 Star Rating will be recognized and published on the NRRS website. Promotional materials will be provided to those participants for their use publicizing their recognition. Participants will qualify quarterly, and have opportunities to promote themselves as 4 or 5 Star winners. For those participants not reaching a 4 or 5 Star recognition, the dashboard will show them areas that need improvement. This program is structured to lift and educate all participants to be better and recognize those that achieve high patient satisfaction results. Participants that receive a 4 or 5 Star will have a page on the website recognizing their accomplishment with their logo so that they can link to the source for validation as well as well-earned recognition.

Ratings and Scoring

The National Rural Honor Roll is created to recognize excellence and help rural hospitals stand out. This platform is open to all U.S. rural hospitals, regardless of their CMS Five Star designation eligibility. Star Rating Awards will be announced quarterly. The National Rural Honor Roll designation is awarded annually and is valid for 12 months, provided the participant maintains a high patient experience rating that meets the established criteria.

The award recognizes facilities with 4- and 5-Star Ratings based on 12 months of patient satisfaction scores from the NRRS. While 4- and 5-Star recipients can promote their quarterly designations, the National Rural Honor Roll is awarded only once per year in Q4 and applies to the following year. Only those facilities with a 4- or 5-Star Rating will be published publicly. The dashboard will show the scoring by domain and overall Star Rating score.

Rules & Compliance

• Data will be collected via secure digital uploads during published submission windows.
• Verified data will be calculated by AdCo.
• Detailed rules will be published regarding Top Box Scores, modes of collection, acceptable questions and other elements at registration.
• NRRS Recognition shall be earned through official CMS Patient Satisfaction scores and calculated quarterly.
• Application for the National Rural Rating System is open to all US Rural Hospitals whether or not they are eligible for the CMS 5 Star Designation due to reporting less than 100 discharges per year.
• Minimum HCAHPS survey responses are established by line calculated over a rolling 12-month period.
• Application for the NRRS is open to all hospitals/clinics/facilities that utilize an external accredited patient experience survey vendor.
• Data will be collected quarterly and displayed with rolling quarters to calculate Star Ratings.
• National Honor Roll Awards for 2025 HCAHPS, announced November of 2024, will be based on Q3/23, Q4/23, Q1/24, Q2/24 (closes 9/22) with data due between 10/9/2024 - 10/25/2024.
• National Honor Roll Awards are announced in November for use the following year. e.g. 2025 Awards announced in November 2024 are based on 2024 data.
• Registered users will have password-protected access to their dashboard for data upload and viewable results data along with other notices and information. Access is provided as long as the organization is subscribed, with annual participation based on the date of enrollment.
• Enrollment is $250 annually per facility and based on the date of enrollment.

Privacy

NRRS and its data vendor AdCo will not sell user information or data. Data may be aggregated and anonymously used for educational purposes and training. Non-identifiable comparisons and calculations may be used or published.

Governance

• Shall consist of a committee including the following representation:
  • Brock Slabach / NRHA
  • Chryspus Muema / NRHA
  • Jake Hanson / Survey Solutions by ICAHN
  • Randy Dauby / Pinckneyville Community Hospital
  • Kristi Clark / Minidoka Memorial Hospital
  • April Warren / Mountrail County Medical Centre
  • Pat Schou / Retired ICAHN
  • Jennifer Gearman / Medi-Sota
  • Jennifer Lundblad / Stratus Health
  • Angie Charlet Schierer / Canopy Associates
  • Brian Lee / Custom Learning Systems
  • Julie Russell / AdCo
  • Amanda Pope / AdCo
• The Governance Board may add additional representatives of established rural health care leadership organizations.
• The Governance Board will exercise full authority and responsibility for the success of this undertaking, including programming and financial matters.
• The Governance Board shall establish an application fee for the purpose of cost recovery.
• The Governance Board shall determine the award criteria for Star Ratings and National Honor Roll.
• The Governance Board shall work under the authority of the NRHA.

Non-Exclusive Adoption by other CMS Certified Vendors

It is the policy of NRRS to ensure this initiative is open and welcoming to any and all certified survey vendors participation.

How Ratings are Calculated

To be published upon review and revision. Existing calculations will be shared with the committee.

Rolling 1 year calendar year.

• Communication with Nurses
• Communication with Doctors
• Responsiveness of Hospital Staff
• Communication about Medication
• Cleanliness of Hospital Env.
• Quietness of Hospital Env.
• Discharge Information
• Care Transitions
• Rating
• Recommend the Hospital
• Also to be provided the number of total HCAHPS survey responses for the year, minimum 24 in a rolling 12 months

Calendar for Submissions

• 2023Q3 - 2024Q2 (July 2023 - June 2024)
  • Submission Window: October 10, 2024 - January 09, 2025
• 2023Q4 - 2024Q3 (October 2023 - September 2024)
  • Submission Window: January 10 - April 09, 2025
• 2024Q1 - 2024Q4 (January 2024 - December 2024)
  • Submission Window: April 10 - July 09, 2025
• 2024Q2 - 2025Q1 (April 2024 - March 2025)
  • Submission Window: July 10 - October 09, 2025
• 2024Q3 - 2025Q2 (July 2024 - June 2025)
  • Submission Window: October 10, 2025 - January 09, 2026

Final corrected data should be available to the hospitals by January 10^th, April 10^th, July 10^th, and October 10^th of every year according to the posted schedule.

History

In 2022, a small group of individuals with a passion for celebrating and promoting the hard work of small and rural health care providers came together to address gaps in current CMS evaluations.

The National Rural Ratings System (NRRS) evaluates rural and critical access health care providers using a comprehensive set of rigorous standards, focusing on key areas like patient satisfaction, quality of care, and overall hospital performance.

This system continues to be a collaborative effort, drawing on the expertise of leading health care organizations and agencies across the country. NRRS began with the support of the Illinois Critical Access Hospital Network (ICAHN), Survey Solutions by ICAHN, Custom Learning Systems, the Wyoming Department of Health, the New Mexico Department of Health, the Louisiana Hospital Association, and AdCo.

After thoughtful communications, the National Rural Health Association currently serves as the home for this project.

Today, NRRS actively provides a well-rounded, data-driven approach to evaluating rural health care institutions under the National Rural Health Association.