Eighteen systems were included in the 2026 list from the federal government. The annual ratings allow patients to gauge medical care quality and can provide motivation for hospitals to improve.
Two hospitals in South Dakota were rated "below average" in 2026 based on a regular review of patient care and medical outcome benchmarks set by the federal government.
But those poor result were far from the norm, as most hospitals statewide received average or better grades in the annual Overall Hospital Quality Star Ratings determined by the U.S. Centers for Medicare & Medicaid Services (CMS).
Get free, fact-based South Dakota news and information in a weekday email. No spam. Cancel any time.
The ratings – ranging from 1 star on the low end to 5 stars at the top – are based on 46 quality measures within five general categories of health and safety data, which are supplied by the facilities being rated or collected independently by CMS. The categories include mortality, safety of care, readmission, patient experiences and timely and effective care.
The two South Dakota hospitals rated 2 stars in 2026 were Avera St. Mary's in Pierre and Huron Regional Medical Center. Both had some positive and negative findings in their overall reviews, but they had lower-than-average recommendation rates by patients.
No South Dakota hospital had a 1-star or 2-star rating in 2025.
Five hospitals received top 5-star marks in 2026, up from three last year. The top grades went to Avera Heart Hospital in Sioux Falls, Avera St. Benedict in Parkston, Sanford USD Medical Center in Sioux Falls and the Veterans Affairs hospitals in Sioux Falls and Sturgis.
Bart Pfankuch
Taken as a whole, South Dakota's ratings were slightly better on average than the rankings of the nearly 3,000 American hospitals that receive a CMS star rating each year.
Ratings only one way to judge hospital quality
The rating system, found at the Care Compare website, "displays hospital performance data in a consistent, unified manner to ensure the availability of credible information about the care delivered in the nation’s hospitals," according to CMS.
Tim Rave, CEO of the South Dakota Association of Healthcare Organizations, declined to comment on any individual hospital's rating.
But he called the ratings "an important benchmark" and added they are far from the only metric hospitals and the public should use to evaluate the quality of patient care.
"While the overall star rating provides helpful information for consumers, hospital leaders rely on much more detailed data to identify opportunities for improvement and ensure they are providing safe, high-quality care," Rave said in an email to News Watch.
Rave said the ratings provide a useful "snapshot" of hospital performance in a confined period of time but can't fully encapsulate the hundreds of data points providers use to evaluate and improve their performance.
"A single overall rating cannot fully capture the complexity of caring for diverse patient populations, the broad range of services hospitals provide, or the unique role each hospital plays within its community," Rave wrote.
How did each South Dakota hospital rate?
Here is a look at how each South Dakota hospital that was rated fared in 2026, with the 2025 Star Rating included in parentheses where applicable. Several hospitals in the state did not have high enough patient counts or data reports to qualify for a CMS rating.
5 stars (much above average):
- Avera Heart Hospital, Sioux Falls (5 stars in 2025)
- Avera St. Benedict Health Center, Parkston (no rating in 2025)
- Sanford USD Medical Center, Sioux Falls (4 stars in 2025)
- VA Medical Center, Sioux Falls (5 stars in 2025)
- VA Healthcare System, Sturgis (4 stars in 2025)
4 stars (above average):
- Avera McKenna H/UMC, Sioux Falls (3 stars in 2025)
- Avera Queen of Peace, Mitchell (no rating in 2025)
- Avera St. Luke's, Aberdeen (5 stars in 2025)
- Brookings Health System, Brookings (4 stars in 2025)
- Monument Health, Spearfish (no rating in 2025)
- Sanford Medical Center, Aberdeen (4 stars in 2025)
3 stars (average):
- Avera Sacred Heart, Yankton (4 stars in 2025)
- Monument Health, Rapid City (4 stars in 2025)
- Prairie Lakes Healthcare, Watertown (4 stars in 2025)
2 stars (below average):
- Avera St. Mary's, Pierre (3 stars in 2025)
- Huron Regional MC, Huron (no rating in 2025)
1 star (much below average):
- No South Dakota hospital at this rating
- Deficiencies found at two lowest-rated hospitals
Huron and Pierre numbers explained
Huron Regional Medical Center, one of the two 2-star rated hospitals in South Dakota, received strong marks for efficiency in emergency room treatment times and for safe use of opioids.
But the hospital received lower-than-average marks in quality of sepsis care, the death rate for pneumonia patients and the overall death rate of patients, which was 5.4% compared to the national average of 4.2%.
The hospital did not participate in any programs to improve maternal or child health outcomes.
The hospital was also cited for low marks on some areas of in-patient surveys. Only 63% of patients at Huron Regional said their rooms and restrooms were always clean, compared to an average of 77% of perfect cleanliness reports at other South Dakota hospitals. And 57% of patients would recommend Huron Regional, compared to an average recommendation rate of 76% at other hospitals statewide.
Join other South Dakotans and support statewide, fact-based news and information.
Pierre's St. Mary's received strong marks in sepsis care and colonoscopy follow-up screening as well for consistent communication to patients by doctors and nurses.
But St. Mary's received lower-than-average ratings in the rate of stroke patients who received rapid brain scans and for longer-than-average treatment times in the emergency room.
The hospital's death rate for heart attack patients was 17.3%, above the U.S. average of 11.6%. CMS also noted that a lower-than-average number of mammogram patients received advanced screening after their initial test.
Only 61% of patients said on surveys that they would recommend St. Mary's, compared to the statewide average recommendation rate of 76% at other hospitals.
Hospitals use ratings as motivation
Cale Feller, director of media relations and corporate communications for Avera Health, told News Watch in an email that the health system is dedicated to constant improvement in patient care.
Feller said the CMS ratings use data from as far back as 2021 and there is a slim margin between star rating levels.
"Avera’s commitment to deliver safe, effective and compassionate care remains steadfast," Feller wrote to News Watch in an email. "Our quality data remained consistent with last year, reflecting the high standard of care we provide."
The CMS hospital rating website shows that while some data used to determine star ratings is from 2021, much of the new analysis is based on information from 2023 and 2024.
Feller did not specifically address the CMS rating for Avera St. Mary's in Pierre, which fell from a 3-star rating in 2025 to a 2-star rating this year.
Monument Health representatives said they have taken numerous steps toward improving patient care and outcomes at Rapid City Hospital, which raised its star rating from a 1 in 2023 to a 4 in 2025. The Rapid City hospital fell to a 3-star rating this year.
For several years, Monument in Rapid City has implemented a "daily huddle" and 5-tier prioritization system in which problems are documented and addressed as quickly as possible.
"Many of our quality outcomes remain strong and continue to improve," Melissa Haught, director of communications at Monument Health, wrote to News Watch in an email.
Haught said the hospital has seen continued reductions in hospital-acquired infections and surgical complications in hip procedures, among other improved outcomes.
"Rapid City Hospital performs better than the national average on seven of the 11 measures included in CMS's hospital readmissions domain, demonstrating strong performance across several key indicators of patient outcomes," Haught wrote.
Both Feller and Haught said their health systems have used the CMS ratings as motivation to improve, and that both systems took specific actions to improve patient care and potentially boost future ratings.
That sentiment was shared by Destiny Price, chief operating officer at Huron Regional, which voluntarily entered into the CMS evaluation system last year, knowing that some deficiencies would likely be highlighted in the rating.
"We recognized the value of being transparent to identify where we’re not hitting all the targets so we can start working on those things," Price told News Watch in an interview.
For example, before the 2-star rating was announced, leaders of the 25-bed hospital recognized issues in sepsis care and took steps to minimize infections and improve outcomes, Price said.
Huron Regional has also created a multi-disciplinary team that meets daily with each hospitalized patient, added a chronic care nurse and community health worker, and has a renovated birthing center and a new robot to aid in orthopedic surgeries. The hospital has also implemented processes to analyze systems and outcomes to identify and solve any issues that arise.
"The quality of care we deliver now is not reflected in the rating," she said. "The board opted to say, 'Hey, let's report (to CMS), and we know it might be painful, and we might get a black eye ... but if we're working hard and always being aware of patient safety, then we'll have better outcomes for our family, friends and community members, which is who we take care of.'"
South Dakota News Watch is an independent nonprofit. Read, subscribe for free and donate at sdnewswatch.org. Contact content director Bart Pfankuch: 605-937-9398/bart.pfankuch@sdnewswatch.org.
