Now Open HCAHPS Applications for the 2024 Rural Star Rating Review

We are pleased to introduce the National Rural Honor Roll with star ratings, a game-changing recognition of critical access and rural hospitals.

Deadline for 2024 Applications is Friday, 10/27/2023

Register Now

Star Ratings

See our 2024 Winners

National Rural Honor Roll

See Honor Roll

Situation Analysis

Currently, the CMS Care Compare star recognition program requires a minimum of 100 annual inpatient discharges to qualify – and that excludes over 60% of Critical Access hospitals in the United States. This is not only because of a low number of qualifying inpatients, but also because it does not include swing beds which are a core service for rural, community hospitals. Currently, there is no other alternative recognition program for rural hospitals.

Our Solution

Time for year two! The National Rural Rating System continues to step up and establish credible criteria for a rating system for Rural, Critical Access, Emergency Departments and Clinics. The goal is to help hospitals achieve greatness, receive recognition for improvements in quality of care as well as 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.

This initiative is open and welcoming to any and all 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.

Next Steps

HCAHPS review is now open. Create your account, submit the application fee of $250* and sign up to be reviewed for 4 or 5 star status. Unless you are using a survey provider that provides us your data (Survey Solutions), you will need to provide the data for review from a CMS certified vendor. Please provide your CMS upload files for for Q3/22 Q4/22 Q1/23 and Q2/23 or a rolling year report from your survey company for Q3/22 Q4/22 Q1/23 and Q2/23. For both top box and percentile rankings. Please include the domain totals, with cleanliness of hospital and quietness of hospital separately. Also include hospital rating and recommend the hospital. We will need to verify number of surveys returned to qualify our minimum requirements. Please email this information to:



Hospitals will register online for inclusion in the program ($250/yr). Data will be accepted quarterly for review and received via a secure portal. The goal is to use data exports hospitals and clinics are already using for other submissions to CMS and AHRQ.


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

For CG Clinical Groups (Coming Soon)

  • Participate in the CG patient experience rating program
  • Utilize an external accredited patient experience vendor
  • Report a minimum of 100 patients over a rolling 12-month period

For Swing Beds (Coming Soon)

  • A minimum of 12 swing bed discharges over a rolling 12-month period
  • Utilize an external CMS-certified swing bed survey vendor

Rules & Compliance

  • Data will be collected via secure digital uploads during published submission windows
  • Verified data will be calculated with dashboard access by Survey Solutions by ICAHN/AdCo
  • Detailed rules will be published regarding Top Box Scores, modes of collection, acceptable questions and other elements at registration
  • National Star Rating Recognition shall be awarded by domain 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
  • Application for the NRRS is open to all hospitals/clinics 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 2023, announced November of 2022 will be based on Q3/21, Q4/21, Q1/22, Q2/22 (closes 9/22) with data due by 10/21/2022

Governance Board

  • Shall consist of a representative of the founding groups of organizations: ICAHN, Survey Solutions and Custom Learning Systems. AdCo may attend as an ex officio member.
  • Governance Board may add additional representatives of established rural healthcare 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, at the appropriate time, incorporate as a voluntary not-for-profit association

NRRS Task Force

  • Pat Schou, ICAHN
  • Pat Goodberry, Custom Learning Systems
  • Brian Lee, Custom Learning Systems
  • Dorian Nottebrock, Custom Learning Systems
  • Jake Hanson, Survey Solutions by ICAHN + AdCo
  • Julie Russell, Survey Solutions by ICAHN + AdCo
  • Kyle Cameron, Wyoming Department of Health
  • Martina Garcia, New Mexico Office of Primary Care & Rural Health
  • Louisiana Hospital Association

Non-Exclusive Adoption by Other CMS Certified Vendors

It is the policy of the Board to make its resources and materials available to any and all certified CMS HCAHPS Vendors and/or certified CG CAHPS Vendors (AHRQ Certified Vendors) and/or CMS HCAHPS Vendors who provided Emergency Department Certified Surveys

This initiative is open and welcoming to any and all certified survey vendors participation