When it comes to quality of medical care and patient safety, South Dakota hospitals generally fared well in new rankings by two independent rating agencies, though there is room for improvement.
In the 2025 quality ratings by the federal Centers for Medicare & Medicaid Services (CMS), three South Dakota hospitals received the top mark of 5 stars, while seven hospitals rated 4 stars and two received 3-star ratings. None of the South Dakota hospitals rated by CMS received a 2-star or 1-star rating, the lowest on the 1-5 scale.
The Overall Hospital Quality Star Ratings are based on 46 quality measures within five general categories of health and safety data, which are supplied by the facilities being rated or are collected independently by CMS. The federal agency rates hospitals and other medical facilities on rates of mortality, safety of care, readmissions, patient experience and timely and effective care.
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.
In all, a dozen hospitals in South Dakota had high enough patient counts to qualify for CMS ratings. Two facilities within the Avera Health system had the highest CMS ratings in South Dakota, with 5-star ratings given to Avera Heart Hospital of Sioux Falls and Avera St. Luke's Hospital in Aberdeen. The other 5-star rating in South Dakota was obtained by the Veteran's Affairs hospital in Sioux Falls.
The lowest ratings in South Dakota were also in the Avera system, where 3-star ratings were given to Avera McKennan Hospital & University Health Center in Sioux Falls and Avera St. Mary's Hospital in Pierre.
The only 1-star rated hospitals in close proximity to South Dakota were MercyOne Siouxland Medical Center and St. Luke's Regional Medical Center, both in Sioux City, Iowa, both of which are owned by UnityPoint Health.
Ratings valuable but only a 'snapshot'
The CMS ratings are valuable for both patients and providers, said Tim Rave, CEO of the South Dakota Association of Healthcare Organizations.
The ratings and specific data points provided by CMS give patients insight into quality measures and outcomes at their local hospitals, he said. But Rave added that the ratings are only a "snapshot in time" of hospital performance and should not be used as the sole source of determining quality of care. In some categories, hospitals can be dinged if patients don't follow up on suggested appointments, he said.
Bart Pfankuch
"I think there's some value. But I don't think it’s driving consumer usage because people are going to go to their community hospital or where their providers recommend them to go," he said.
The ratings also provide hospitals with an independent review and a benchmark upon which to seek improvements.
"It challenges you, whatever facility you're in, to attain a goal," Rave said. "Even if you got to 4 stars, you'd like to be a 5."
Leapfrog grades provide another rating
Earlier this year, the Leapfrog Group – an independent hospital rating organization – also released its annual grades, which range from A at the top to F at the bottom.
Of the nine South Dakota hospitals rated by Leapfrog, seven received grades of C. Monument Health Rapid City Hospital, which has seen its quality ratings improve sharply in recent years, received the only A grade in South Dakota, while Avera St. Mary's in Pierre received the only D grade.
South Dakota's CMS ratings were largely in line with hospital ratings in other states across the U.S. Of roughly 3,000 hospitals rated by CMS in 2025, about 60% of facilities received a 4-star or 3-star rating. About 10% achieved a 5-star rating, and 8% received a 1-star rating.
In recent years, the CMS quality ratings have shown a general decline across the U.S. The number of 5-star rated hospitals fell from 455 in 2021 to 291 in 2025, and the number of 4-star rated hospitals fell from 998 in 2021 to 761 this year. Meanwhile, the number of 1-star ratings rose from 204 in 2021 to 293 in 2025.
Pierre hospital has lower rankings
With a CMS rating of 3 stars and a Leapfrog grade of D, the lowest in South Dakota in 2025, Avera St. Mary's Hospital in Pierre was flagged by the rating agencies in a number of areas.
CMS rated St. Mary's high in some patient care areas. The hospital scored well in treatment of severe sepsis and septic shock and for its lower-than-average rate of infections from Clostridium difficile, or C. diff. The hospital was also noted for a low readmission rate and a low overall patient death rate of 4.1%, slightly lower than the national average of 4.2%.
However, CMS flagged St. Mary's for its death rate of heart failure patients (17.3%), which was higher than the national average of 11.6%, and for its higher-than-average rate of patients who died of pneumonia. The hospital also had a lower rate of rapid brain scans taken on patients who came to the emergency room with stroke symptoms.
The Leapfrog rating indicated a lower-than-average rate of hand washing by staff at St. Mary's, a high rate of patient falls and injuries and a low rate of safe administration of medications. Leapfrog gave high marks to the hospital for responsiveness of staff and a low rate of problems with surgeries.
Cale Feller, director of media relations at Avera, responded to News Watch questions with an email statement, noting that some CMS data used in the current ratings is from 2021-2023 and is incomplete.
Feller also said the Leapfrog ratings are based on voluntary reporting of data that is time-consuming and expensive.
"For those who do not participate (in Leapfrog surveys), grades are calculated based on incomplete data, which may not accurately reflect performance," he wrote.
In reference to the CMS rating at St. Mary's in Pierre, Feller said, "This information is not reflective of our level of care offered at Avera St. Mary’s.
"Avera St. Mary’s continues to monitor quality rigorously through CMS, Joint Commission and internal quality initiatives, which provide more timely and validated performance metrics. Avera St. Mary’s has hired a dedicated infection control coordinator who reviews all cases and provides real-time guidance and support for care teams. While this is an effective process for improving future ratings – especially when one or two patient cases can impact overall rankings – it’s even better for ensuring high quality care for every patient at every encounter."
Monument Health sees big improvement
Leaders and staff at Monument Health have proven that making a comprehensive, committed effort to improve patient care and outcomes can be successful.
In 2023, Monument's flagship hospital in Rapid City had the state's only 1-star CMS rating. A year later, the rating had risen to 3 stars. And this year, Monument received a 4-star rating.
Monument leaders in 2023 noted that the data used by CMS to evaluate hospitals is outdated, sometimes by a few years, so they felt their performance was not accurately calculated that year.
Furthermore, hospital leadership implemented a series of initiatives to improve performance, morale and outcomes, said Jill Tice, Monument Health vice president of quality, safety and risk management.
That included frequent analysis of data, daily staff huddles where quality is the primary focus, and a multi-tiered safety and quality program. Under the 5-tiered improvement program, any issues or problems are documented and then addressed in a systematic and immediate way by increasing levels of management.
Tice said those steps and others ultimately created a culture of accountability and constant improvement.
"We talk about quality and safety every day," Tice told News Watch. "We have caregivers and physicians involved at the front lines, keeping safety at the forefront of our thoughts."
Tice said Monument will now strive for a 5-star rating and that both patients and staff should notice Monument's improvements when they visit the hospital.
"I think they will feel a difference," she said. "When you move the culture forward and improve service delivery, safety and overall quality, you feel that spill over into all areas of service."
This story was produced by South Dakota News Watch, an independent, nonprofit organization. Read more stories and donate at sdnewswatch.org and sign up for an email to get stories when they're published. Contact Bart Pfankuch at bart.pfankuch@sdnewswatch.org.
