1 3 7 5 6 2 13 11 15 16 8 9 41 30 12 14 21 32 10 45 31 4 43 18 26 35 22 28 44 42 50 17 20 47 25 36 34 48 39 38 19 23 33 27 24 46 37 29 40 49
Injured African American veteran in wheelchair talks with military psychiatrist. Both men are seen from the neck down. Focus is on the wheelchair.

(Steve Debenport/Getty Images)

Health Care Quality Rankings

Measuring the quality of states' Medicare, hospitals and nursing homes


RELATED CONTENT

A thick layer of fog rolls over the Mississippi River toward Dubuque, Iowa, Monday, Oct. 23, 2017. (Dave Kettering/Telegraph Herald via AP)

Iowa Is No. 1


[RELATED: Iowa Is No. 1]

Health care quality holds one-third of the weight in ranking the Best States for health care. Four metrics – Medicare quality, hospital readmissions, nursing home quality and preventable hospital admissions – contributed to the rankings. Though this subcategory’s rankings are determined by only four metrics, they offer a broad and multifaceted outlook on the state of health care in the nation. Health care quality is intrinsically linked to health care accessibility, and it contributes heavily to a state's population health, the other two subcategories used to determine the Best States for health care.

Hawaii, the top state for health care, also ranks No. 1 for healthcare quality, followed by Utah and Washington. Interestingly, Alaska, which has the worst health care access in the country, ranks No. 4 for health care quality, with one of the lowest hospital readmissions rates and preventable admissions rates.

Southern states, including Louisiana, Kentucky and Mississippi, comprise all of the bottom 10 states.

Best States for Health Care Quality

Health Care Quality Rank State Fewest Hospital Readmissions Medicare Quality Nursing Home Quality Preventable Admissions
#1 Hawaii HI 1 17 12 1
#2 Utah UT 3 14 7 3
#3 Washington WA 7 10 3 5
#4 Alaska AK 5 - 17 6
#5 Colorado CO 6 9 11 7
#6 Idaho ID 2 24 15 2
#7 North Dakota ND 13 2 2 28
#8 Oregon OR 11 15 16 4
#9 Iowa IA 15 3 21 16
#10 Maine ME 16 6 20 19
#11 South Dakota SD 8 1 23 31
#12 Nebraska NE 9 18 9 17
#13 Rhode Island RI 41 5 1 23
#14 California CA 30 11 14 11
#15 Wisconsin WI 12 25 18 14
#16 Arizona AZ 14 36 8 9
#17 Minnesota MN 21 4 5 43
#18 Vermont VT 32 8 30 10
#19 Delaware DE 10 33 6 33
#20 Connecticut CT 45 13 10 20
#21 New Hampshire NH 31 12 36 18
#22 Montana MT 4 48 24 12
#23 New Jersey NJ 43 26 4 24
#24 Kansas KS 18 29 29 26
#25 Wyoming WY 26 43 27 13
#26 Pennsylvania PA 35 16 39 25
#27 Maryland MD 22 22 38 27
#28 Ohio OH 28 21 34 39
#29 Nevada NV 44 28 35 15
#30 Michigan MI 42 20 26 32
#31 Massachusetts MA 50 7 28 30
#32 Indiana IN 17 44 25 38
#33 New Mexico NM 20 34 49 8
#34 Florida FL 47 19 13 41
#35 South Carolina SC 25 42 33 29
#36 Missouri MO 36 27 37 35
#37 Illinois IL 34 23 42 36
#38 New York NY 48 39 22 21
#39 Alabama AL 39 35 19 44
#40 Tennessee TN 38 31 32 46
#41 North Carolina NC 19 40 48 34
#42 Oklahoma OK 23 32 43 42
#43 Virginia VA 33 47 44 22
#44 Georgia GA 27 38 46 37
#45 Texas TX 24 41 50 40
#46 Arkansas AR 46 45 31 45
#47 West Virginia WV 37 30 40 48
#48 Louisiana LA 29 37 47 47
#49 Kentucky KY 40 46 45 50
#50 Mississippi MS 49 49 41 49

Fewest Hospital Readmissions

This metric evaluates the hospital readmission rate of states in 2016. Hospital readmission is measured when a patient is admitted to any hospital within 30 days of being discharged from an initial earlier hospitalization. A lower rate indicated a better ranking for this metric. Hawaii, the No. 1 state for health care, boasted the lowest readmission rate, with slightly more than 14 percent of patients returning to the hospital. Though Massachusetts ranked fifth for health care and has the best health care access in the country, it ranked last for its hospital readmission rate.

Medicare Quality

This measures the percentage of a state’s Medicare Advantage enrollees whose plans have at least a 4-star rating from the Centers for Medicare & Medicaid Services. Medicare Advantage Plans are approved private health insurance plans for people enrolled in Medicare with both hospital and medical insurance. Medicare Advantage Plans generally offer extra coverage, such as vision or dental. Rankings for this metric were determined by mapping December 2017 enrollments to 2018 plan numbers.

Nationally, 58 percent of Americans enrolled in Medicare Advantage had at least a four-star plan. In New England and the Far West, the rate was much higher: 89 percent and 81 percent of people had plans with at least four stars, respectively. The Dakotas came out on top for this ranking, with South Dakota providing its citizens with the best Medicare quality and North Dakota following close behind. In both states, nearly 100 percent of Medicare Advantage enrollees have a 4-star plan or higher.

Nursing Home Quality

Though nursing homes are inspected both regularly and upon complaint, dangerous and neglectful conditions can be prevalent. This metric measures the percentage of nursing home residents in 4-star or better nursing homes in 2017. Data were compiled by the Centers for Medicare & Medicaid Services on all Medicare- and Medicaid-certified nursing homes in the nation with stars. Nationally, 47 percent of nursing home residents are in a facility rated at least 4 stars. In Rhode Island, the No. 1 state for this metric, that number jumps to 65 percent. In North Carolina, New Mexico and Texas the number drops to just above 30 percent.

Preventable Admissions

This metric evaluates the number of preventable hospital admissions in a state per 100,000 beneficiaries. The data, collected in 2015, was gathered by the Centers for Medicare and Medicaid Services. When patients with acute illness or worsening chronic conditions are treated properly at primary care facilities, it prevents their chances of needed ambulatory services and inpatient time at a hospital. In Hawaii, the top ranked state, around 2,080 patients' hospital stays could have been prevented with adequate primary care access and quality. That number was more than double in the Southeast, which lagged behind the rest of the country in preventing hospital stays.