The CMS measures are risk adjusted, which allows for more accurate comparisons between areas with sicker populations and those with healthier populations. The assumption is that patients who receive high quality care during their hospitalizations will likely have better outcomes, at least within the 30 days following a hospital discharge.
The effects of extreme poverty and low incomes still tip the scale, however. A Kaiser Health Foundation study found that hospitals with the highest share of low-income Medicare patients are three times as likely as others to have high readmission rates for heart failure.
Nationwide, 15.3% of hospital patients are readmitted to the hospital within 30 days. Readmission rates in 23 of the 25 cities on this list exceeds that percentage.
Deaths that occur in the 30 days following initial hospital admission is another key metric of the quality of hospital care. Nationwide, 12.7% of patients admitted die within a month. In the 25
cities with the worst hospitals the 30 day mortality rate exceeds this national figure, to as high as 15.4% in the Homosassa Springs, Florida metro area.
According to a 2014 study published in the Journal of General Internal Medicine, in half of U.S. hospitals, 1 in 7 patients admitted for acute myocardial infarction (also known as a heart attack) die within 30 days of admission. Mortality rates among heart attack and other heart-related condition patients are generally high in all 25 cities.
Recent research by the Association of American Medical Colleges and other organizations has pointed to a growing doctor shortage in the United States. The ratio of primary care physicians per population is in some regions considerably lower than the 76 doctors per 100,000 people nationwide, particularly in metro areas with low-rated hospitals. Of the 25 cities with the worst-rated hospitals, 19 have fewer primary care physicians per capita than the national ratio.