RAPID CITY — Monument Health's flagship hospital received the lowest federal quality rating possible over the past two years, according to the Centers for Medicare and Medicaid Services, which helps patients evaluate hospital safety and quality of care.

Monument Health leaders said they are working hard to raise the rating by CMS, which gave the Rapid City hospital a 1 out of a possible 5 star rating. No other hospital in South Dakota or within a 200-mile radius of Rapid City had a 1-star rating in 2023, the latest year the ratings were released.

Among the 14 hospitals in the state that received a CMS quality and safety rating in 2023, no hospital had a 2-star rating, two had a 3-star rating, four had a 4-star rating and seven had a 5-star rating.

In an interview with News Watch, Jill Tice, Monument vice president for quality, safety and risk management, said the hospital takes the CMS ratings very seriously.

"We certainly approach them as though they are very important because this is what's being projected to our community in terms of our performance, so we can't not take them very seriously," she said.

The Overall Hospital Quality Star Ratings are based on 46 quality measures within five general categories of health and safety data.

According to the latest CMS review of Monument, updated in October 2023, the hospital was at or above national averages in several key areas, including in mortality rates for patients with strokes, heart attacks and chronic pulmonary disease.

The hospital also scored well in regard to patients not requiring readmission for any reason after discharge, a low rate of "central-line" catheter infections, and it had a low rate of complications following surgeries. Costs for many procedures were also in line with national averages.

On the other side of the ledger, Monument was below state and national averages for percentage of patients receiving appropriate care for severe sepsis, in regard to length of time of visits to the emergency room, in the rate of surgical site infections after colon surgeries and in percentage of patients that received advanced breast screening after an initial mammogram.

Monument: Old data make rating less accurate

Tice said some of the data used by CMS to create the 2023 ratings is from 2018, so, "it's a representation of who we were, not a representation of who we are now.”. 

Monument has implemented a number of quality and safety improvement procedures in recent years, including a "daily huddle" and five-tier prioritization system in which problems are documented and addressed as quickly as possible, she said.

Monument Rapid City in spring 2023 received a C grade on a scale of A to F from the Leapfrog Group, a national nonprofit hospital evaluation firm.

Leapfrog noted that Monument performed above average in quality of nursing care, high rates of hand washing, safe medication administration, and organization leadership and staff cooperation.

Monument was rated below the national average in several areas, including in sepsis infections after surgery, accidental cuts and tears, dangerous blood clots, surgical wounds splitting open, site infections after colon surgery, patient falls and injuries, and "deaths from serious treatable complications."

For at least the past seven years, Monument has been fully accredited by the Joint Commission, a national nonprofit that awards accreditation. Monument hospital received the commission's Gold Seal of Approval for its three-year accreditation.

CMS provides the public with several ways to evaluate and compare the performance of hospitals.

The Care Compare website tool enables users to examine the quality of a particular medical facility and to compare up to three medical providers. The CMS Overall Hospital Quality Star Rating system enables the public to obtain a snapshot of a facility's quality.

"Patients and families can use the star rating, along with other information on Care Compare, to learn about the quality of hospitals and the services they offer," a CMS spokesman said.

East River hospitals fare better on CMS scale

Monument Health hospital in Spearfish received a 4-star CMS rating in 2023, as did the Veterans Affairs Black Hills Health Care System in Sturgis. The Avera Gregory Hospital in Gregory and Avera St. Mary's Hospital in Pierre both received 3-star ratings. Avera McKennan Hospital in Sioux Falls and Sanford Medical Center in Aberdeen received 4-star ratings.

The 5-star ratings were awarded to Avera hospitals in Yankton and Aberdeen and the Avera Heart Hospital in Sioux Falls, the Brookings Health System, Prairie Lakes Health Care System in Watertown and the Sanford USD Medical Center and VA Medical Center in Sioux Falls.

According to CMS data, fewer than 1 in 10 of all U.S. hospitals rated in 2023 received a 1-star rating. CMS reported that 250 of  3,076 U.S. hospitals rated by the agency in 2023 had a 1-star rating, about 8% of the total.

Meanwhile, 668 hospitals (22%) had a 2-star rating, 872 (28%) had a 3-star rating, 803 (26%) had a 4-star rating and 483 (16%) had a 5-star rating.

The CMS ratings are an important tool to allow patients to quickly gain insight into the recent performance of a hospital and its staff, a process that otherwise would be complicated and unwieldy, said Shelly Ten Napel, CEO of the Community HealthCare Association of the Dakotas in Sioux Falls.

“It’s hard for consumers to really understand if they are getting good health care or if a lot of money is just being put into fancy buildings and high-cost specialty care,” said Ten Napel.

Tice told News Watch that based on current data, Monument leadership expects to see improvement in ratings this year.

"Can we get to a 5 in this next (CMS rating) release? No. Can we get there someday? Absolutely we can, and we will," she said. " So do I feel safe coming and getting care here? Absolutely."

This story was produced by South Dakota News Watch, a nonpartisan, nonprofit news organization. Read more in-depth stories at sdnewswatch.org and sign up for an email every few days to get stories as soon as they're published. Contact Bart Pfankuch at bart.pfankuch@sdnewswatch.org.