Quality rating systems exist to grade the value of care provided by hospitals, but the extent to which these rating systems correlate with patient outcomes is unclear. The association of quality rating systems and hospital characteristics with excess readmission penalties for total hip arthroplasty (THA) and total knee arthroplasty (TKA) was studied.
The fiscal year 2022 Inpatient Prospective Payment System final rule was used to identify 2,286 hospitals subject to the Hospital Readmissions Reduction Program. Overall, six hospital quality rating systems and five hospital characteristics were obtained. These factors were analyzed to determine the effect on hospital penalties for THA and TKA excess readmissions.
Hospitals that achieved a higher Medicare Overall Hospital Quality Star Rating demonstrated a significantly lower likelihood of receiving THA and TKA readmission penalties (Cramer’s V = 0.236 and r = -0.233; P <0.001 for both). Hospitals ranked among the U.S. News & World Report's (USNWR) top 50 Best Hospitals for Orthopedics were significantly less likely to be penalized (V = 0.042; P = 0.043). The remaining four quality rating systems were not associated with readmission penalties. Penalization was more likely for hospitals with fewer THA and TKA discharges (r = -0.142; P < 0.001), medium-sized institutions (100 to 499 beds; V = 0.075; P = 0.002), teaching hospitals (V = 0.049; P = 0.019), and safety net hospitals (V = 0.043; P = 0.039). Penalization was less likely for West and Midwest hospitals (V = 0.112; P < 0.001).
A Higher Overall Hospital Quality Star Rating and recognition among USNWR’s top 50 orthopedic hospitals were associated with a reduced likelihood of THA and TKA readmission penalties. The other four widely accepted quality rating systems did not correlate with readmission penalties. Teaching and safety net hospitals may be biased towards higher readmission rates.

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