Nevada hospitals lag far behind their national counterparts on a variety of quality of care measurements rated by the federal government. But a seminal provision of Obamacare that hits hospitals where it hurts may be improving outcomes for patients.

Nationally, more than half of the 4,000 Medicare-certified hospitals scored by the Centers for Medicare and Medicaid Services (CMS) received either three or four stars on the five-star scale.

CMS ranked 25 of Nevada’s 37 hospitals. None received the highest rating of five stars, only 28 percent received three or four stars, another 28 percent received two stars, while almost half (44 percent) scored just one star.

Throughout the United States, seven percent of rated hospitals received five stars, 25 percent received four stars, 26 percent received three stars, 16 percent received two stars and only five and one-half percent received one star.

Scores are available at Hospital Compare, a consumer website from CMS that serves a dual purpose: It helps patients make decisions about where to get health care and also acts as an incentive to hospitals to improve care.

Amy Shogren of the Nevada Hospital Association told the Current the association has no comment on the ratings.

CMS rates hospitals based on seven factors: mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging.

As part of the Affordable Care Act’s effort to ensure quality care, in 2012 Medicare began assessing fines to hospitals based on the number of patients readmitted within 30 days for any of six conditions:

Chronic lung disease

Coronary artery bypass graft surgery

Heart attacks

Heart failure

Hip and knee replacements

Pneumonia

Fines against “safety net” hospitals, those that care for a large percentage of patients who live in poverty, will be reduced in Fiscal Year 2019, thanks to a Medicare rule change. Those hospitals have long complained that readmission rates for poor patients are likely to be higher than those of affluent patients for a variety of reasons that may have little to do with hospital care.

In fiscal year 2019, the government will fine 2,599 hospitals some $566 million by withholding reimbursements, according to Kaiser Health News. That’s up slightly from $564 million in 2018 and $528 million in 2017.

The average penalty is less than one percent but can amount to as much as three percent of the government’s scheduled payment. For fiscal year 2017, the last year data is available, CMS fined 20 hospitals in Nevada. New data for fiscal year 2018 has been released to hospitals but not the public.

Critical access hospitals, which are located in rural areas, are exempt from fines.

Here’s where Nevada hospitals stand, and the categories where they performed either above or below the national average. CMS weights the measures for hospitals that lack data in some of the areas measured.

Four-star hospitals

Desert View in Pahrump scored below the national average in the efficient use of medical imaging. Data was unavailable for safety of care, patient experience, effectiveness of care and timeliness of care.

Mesa View Regional in Mesquite scored above-average in the categories of patient experience and timeliness of care.

St. Mary’s Regional Medical Center in Reno scored above the national average in safety of patient care, below the national average in readmission and below the national average in patient experience. The hospital has been fined four out of five years for patient readmissions within 30 days.

Three-star hospitals

Carson Tahoe Regional Medical Center in Carson City scored below the national average in readmissions and has been fined four out of five years the government’s Readmission Reduction program has been in existence. The hospital scored below the national average inpatient experience, timeliness of care, and efficient use of medical imaging.

Carson Valley Medical Center in Gardnerville scored below the national average in readmissions.

Humboldt General Hospital in Winnemucca scored below the national average in readmissions.

Northeastern Nevada Regional Hospital in Elko scored above the national average in readmissions and has been fined all five years the Readmission Reduction program has been in effect. NNRH scored above the national average in safety of care and below in patient experience.

Two-star hospitals

Boulder City Hospital is below the national average in the number of readmissions.

Mount Grant General in Hawthorne is below the national average in readmissions.

Renown South Meadows Medical Center in Reno scored below the national average in readmissions. It has been fined three of five years the Readmission Reduction program has existed. The hospital scored below the national average in safety of care.

Southern Hills in Las Vegas scored below the national average in safety of care and readmissions. It has been fined in five previous years for its readmission rate.

“Southern Hills Hospital is dedicated to providing high-quality patient care and improving in every hospital quality measurement,” spokeswoman Jennifer McDonnell said in a statement, noting the hospital’s recognition for treating a variety of ailments. “We are continually looking for ways to elevate our patients’ experience and our overall quality through increased nurse leader rounding on each unit and in the Emergency Department and through our patient advocate program which addresses patient satisfaction in near real-time. We have a focus on Infection Prevention to find ways to prevent the spread of infection throughout the facility. Additionally, we have 24/7 intensivists to provide critical care to patients.”

St. Rose de Lima in Henderson rated below the national average for mortality. Its rating for patient experience and timeliness of care were below the national average. The hospital has been fined by CMS for readmissions all five years the reduction program has existed. It is owned by Dignity Health.

The mortality rate at MountainView Hospital in Las Vegas was below the national average in 2017. The facility scored below the national average in patient experience and timeliness of care, but above the national average in the efficient use of medical imaging. Mountainview scored above the national average in the rate of readmissions and has been fined all five years of the reduction program. MountainView is owned by Hospital Corporation of America (HCA).

“We look forward to seeing improvement of our star rating as our improved performance continues,” the hospital said in a statement to the Current, pointing out its many certifications and an ‘A’ rating from The Leapfrog Group’s Fall 2018 Hospital Safety Grade.

North Vista in North Las Vegas scored above the national average in safety of care and below the national average in patient experience and timeliness of care. Although it rated below the national average for readmissions, North Vista has previously been fined by CMS all five years of the reduction program.

One-star hospitals

Centennial Hills scored above the national average in the efficient use of medical imaging but below the national average in the areas of safety of care, patient experience of timeliness of care. The hospital is owned by Universal Health Services, a Pennsylvania-based, publicly traded corporation. Centennial Hills has been fined all five years by CMS for its readmission rate, but scored below the national average this year. a spokeswoman for UHS did not respond to our requests for comment.

Desert Springs, another UHS hospital, scored below the national average in mortality, safety of care, patient experience and timeliness of care. The hospital was above the national average in the efficient use of medical imaging. Desert Springs was below the national average in the percentage of readmitted patients but has been fined all five previous years for its readmission rate.

Renown Regional Medical Center in Reno scored below the national average in mortality, safety of care, patient experience and timeliness of care. It scored above the national average in readmissions and has been fined by CMS all five years.

Spring Valley in Las Vegas is owned by UHS. The facility scored below the national average in safety of care, patient experience and timeliness of care. The hospital scored below the national average for readmissions but has been fined all five years previous years of the reduction program.

St. Rose San Martin in Las Vegas, owned by Dignity Health, scored below the national average in safety of care and timeliness of care. It scored below the national average in readmissions but has been fined for five years by CMS. Dignity Health did not respond to our requests for comment.

St. Rose Siena in Las Vegas, also owned by Dignity, scored below the national average in mortality, safety of care, patient experience and timeliness of care. It scored above the national average in efficient use of medical imaging. It has been fined by CMS four out of five years the reduction program has been in existence.

Summerlin Hospital in Las Vegas is owned by UHS. It ranked below the national average in safety of care, patient experience and timeliness of care but above the national average in mortality. Although it ranked below the national average in readmissions, Summerlin Hospital has been fined all the previous years of the reduction program.

Sunrise Hospital, which is owned by HCA, ranked below the national average in mortality, safety of care, patient experience and timeliness of care. Sunrise rated above the national average in the efficient use of medical imaging. Sunrise rated below the national average for readmissions but has been fined by CMS the previous five years of the readmissions reduction effort.

“We are continually looking for ways to elevate our patients’ experience and our overall quality through increased nurse leader rounding on each unit and in the Emergency Department and through our patient advocate program which addresses patient satisfaction in near real-time,” a Sunrise spokeswoman said in a statement. “We have a focus on Infection Prevention and decreasing use of restraints every day in the hospital. This includes a culture that staff embrace to acknowledge patients and visitors. We strive to introduce ourselves, set expectation about the duration of the visit or procedure, provide an understandable explanation of the care they will receive and thank each patient for placing their health in our hands.”

University Medical Center is the public hospital in Southern Nevada. It ranked below average in safety of care, patient experience and timeliness of care.

“The rating system fails to accurately reflect UMC’s success in promoting patient safety and offering Nevada’s highest level of care,” the hospital said in a statement. UMC rated below the national average for readmissions this year, but has been fined all five previous years by the CMS reduction program.

Valley Hospital in Las Vegas is owned by UHS. It ranked below the national average in safety of care, patient experience and timeliness of care. The hospital has been fined by CMS for the first five years of the readmissions reduction program, but its rate was below the national average in 2017.