WASHINGTON (Tribune News Service) — Many of the worst VA hospitals in the country last year remain among the worst this year, according to internal rankings released Wednesday by the Department of Veterans Affairs.

Nearly a dozen of the medical centers who received one out of five stars in quality ratings this year received the same low score in 2016.

They include three veterans’ hospitals in Tennessee — in Nashville, Murfreesboro, and Memphis, where threats to patient safety have skyrocketed in recent years. Also among them is the Phoenix VA, where veterans died waiting for care touching off a national scandal in 2014.

Two hospitals in Texas — in El Paso and Big Spring — and two in California — in Loma Linda and Fresno — also made the list of two-time, one-star facilities.

At the same time two hospitals managed to shake their one-star status. Facilities in Detroit and Fayetteville, N.C., improved to two-star VA hospitals.

The VA regularly scores 146 of its medical centers based on dozens of quality factors, including death and infection rates, instances of avoidable complications and wait times. The agency uses a five-star scale with one being the worst and five being the best.

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The rankings compare VA hospitals against each other but the number of one-star hospitals is not constant. Medical centers in that bracket can be elevated to two stars based on quality-of-care factors.

The agency did not start releasing the ratings until USA TODAY obtained and published them for the first time last December. The VA then committed to posting them annually.

VA Secretary David Shulkin, who took over in February, has said he is committed to making the VA “the most transparent organization in government.”

"Secretary Shulkin has been clear that transparency is a crucial component of our efforts to reform the department," VA Press Secretary Curt Cashour said Wednesday. "That’s why we’re posting these important end-of-year ratings, which document improvements at 64% of rated VA medical centers."

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