The most recent federal hospital quality rankings only listed one five-star medical center in Hawaiʻi — and it’s not the state’s largest.

The Queen’s Medical Center — which was founded in 1859 in Honolulu and is the state’s largest private, nonprofit hospital — dropped to three stars in rankings released last month by the Centers for Medicare and Medicaid Services.

On the Windward side of Oʻahu, Adventist Health Castle in Kailua scored five stars for the third year in a row, placing it in the top 10% of the 2,891 hospitals ranked by CMS nationwide.

The federal agency awards one to five stars to about 60% of the nation’s hospitals annually, providing a measure to compare facilities based on publicly reported data in the categories of mortality, safety of care, readmission, patient experience and timely and effective care.

Other states with only a single five-star facility include Alaska, Delaware, Connecticut, New Hampshire and Wyoming.

Ninety-one fewer hospitals in the nation qualified for a five-star rating in 2025 than in 2024, the data also show, making the renewed Adventist ranking more significant.  

The CMS star rating is especially valuable because it’s unsolicited, unsponsored and an evidence-based indicator of clinical outcomes and patient experience, Helen Linton, Adventist Health Castle’s communication manager, said in an email. 

“The star rating is a simple but trusted measure that can guide healthcare decisions,” Linton said.

The CMS website said patients and families can use the star rating to “compare facilities side-by-side and ask quality-related questions when visiting a hospital.”

In its August update, CMS reported that The Queen’s Medical Center dropped one place from four to three stars, after holding four between 2022 and 2024. It last held a five-star rating in 2021.

Queen’s Health Systems Chief Operating Officer Darlena Chadwick said the facility recognizes the importance of the star rating as a tool to decide which hospital might be the best fit for an individual.

“As with every hospital around the country, we are constantly looking for ways to improve the care we deliver to our patients, and we are dedicated to promoting an environment of open communication, teamwork, and continuous learning every day,” Chadwick said in an emailed statement.

“It is also important to note that some of the data reflected in the star rating is two years old, and in some cases, up to five years old,” she added. “Since then, Queen’s is proud to have made improvements in many of the areas of measurement, specifically in mortality and readmission rates.”

How Did Other Hospitals Rank?

Three other Honolulu hospitals had four-star rankings. The Straub Benioff Medical Center and Pali Momi Medical Center maintained their ranks from last year, while Kuakini Medical Center improved its rank by one place.

The three-star rating places Queens firmly in the middle third of the nation’s hospitals alongside Kaiser Permanente Moanalua Medical Center in Honolulu and Maui Memorial Medical Center, which maintained their previous ranks.

The state’s two-star facilities include Wilcox Memorial on Kauaʻi, and Hilo Benioff Medical Center, Queen’s North Hawaiʻi Community Hospital and Kona Community Hospital on the Big Island. Kona Community Hospital also moved up by one star from last year.

As acute care hospitals, only those 11 facilities are required to submit data for these rankings. That omits Tripler Army Medical Center and a number of critical access hospitals such as Lānaʻi Community Hospital, Kohala Hospital and Kula Hospital. 

The agency also doesn’t assess data from the Kapiʻolani Medical Center for Women and Children.

See the full table below.

More On The Data

Hospitals don’t necessarily submit data for all 45 quality measures to the Centers for Medicare and Medicaid Services for the rankings, but have to submit information for three measures in at least three categories.

One of those categories must be mortality or safety of care, which measures things like rates of death for heart attack and stroke patients, surgical site infections and catheter-associated urinary tract infections.

The CMS also weighs rates of readmission after discharge and the percentage of patients who left the emergency department without being seen. 

The CMS website said shifts in a hospital’s overall star rating are to be expected as performance measures “are added, removed and updated … and as data periods for various measures are refreshed.” 

The overall methodology for the rankings has been the same since January 2021 however, according to the CMS website and based on data available as of October 2024. 

The agency first released the rankings in 2016. The star ratings supplement other information that can be accessed via the CMS Care Compare search tool.

“Data Dive” is supported in part by the Will J. Reid Foundation.