National HCAHPS Averages: Benchmarks for 2024–2025

By Jason Messerli, Strategic Advisor, Customer Strategy, NRC Health

Halfway through a quarterly review last fall, a CNO I work with put a number on the screen and asked what I thought of it. Communication with Nurses, top-box, 78 percent. 

Was it good? She wanted a number to compare it against, and the room was quiet because nobody had one ready. 

This article is the answer I gave her, written for the patient experience (PX)  leader who needs to walk into the next quality committee meeting with more than an HCAHPS percentage and a hopeful expression. We will look at where the field sits in the most recent reporting period, what’s improving and what isn’t, and how to use HCAHPS national benchmarks without falling into the three traps I see hospitals fall into most often. 

NRC Health’s CAHPS solutions help PX teams put benchmark data to work. 

Key Takeaways 

• The percentile distribution tells you a lot more than the national mean does, and it’s also what the star clustering algorithm uses every quarter. The 5th, 25th, median, 75th, and 95th together show where the field spreads out. 
• The biggest gains in HCAHPS happened early. Doctor Communication has only moved by +0.8 percentage points over more than a decade, while the Hospital Overall Rating has moved by +8.5. The field has compressed since 2013, which is part of why a 4-star is harder to hold onto today than it used to be. 
• A peer group of hospitals that operate like yours beats the national average in serious target-setting. 
• Cut-points get recalculated every quarter against the current national performance. Your scores can climb year over year, and your public star can still drop if the rest of the field climbs faster. 
• The benchmark roster is shifting in 2026. Three new HCAHPS domain measures are expected to enter public reporting at the October 2026 Care Compare refresh, and OAS CAHPS measures will start impacting the Overall Hospital Quality Star Rating in May 2026.

It’s the number you get when you average HCAHPS scores across every U.S. hospital that submits data in a given four-quarter window. Two versions get tracked. Top-box and linear mean. 

CMS posts the national numbers quarterly on the HCAHPS Online Summary Analyses page. New data usually shows up within a week of the Care Compare refresh. 

The most useful benchmark for a working Patient Experience (PX) team isn’t the national average alone. The percentile distribution (5th, 25th, median, 75th, 95th) tells you where you sit in the field, which is the comparison the star clustering algorithm cares about each quarter. 

For the July 2025 percentiles report, which covers discharges from October 2023 through September 2024, the median hospital had a top-box score of 80 on the Communication with Nurses  composite. The 5th percentile sat at 69. The 95th sat at 92 (HCAHPS Online — 2025 July Percentiles Public Report). 

The 23-point spread is doing a lot of work in those numbers. The median tells you the middle of the field. The 5th and 95th tell you how far apart the bottom and top of the field are. 

A hospital at 78 percent on Nurse Communication isn’t really an average hospital. It’s below the 50th percentile but well above the 5th. That puts it in the band where a couple of points of movement can cross a percentile line that matters for Hospital Value-Based Purchasing (VBP). 

For the individual question top-boxes in the January 2025 reporting period, Nurse Courtesy and Respect (Q1) was 87 percent. The other Nurse Communication items typically run in the high 70s through mid-80s during that period. 

If you want the most up-to-date numbers, the Summary Analyses page refreshes each quarter. The current cadence puts new data on the site within a few business days of the Care Compare refresh. 

Twelve years of public reporting gave researchers enough runway to see what hospitals did with HCAHPS. A peer-reviewed analysis covering HCAHPS 2007 through 2019 found that top-box scores rose an average of 5.2 percentage points across HCAHPS measures over that window. 

Most of the gain happened early. 

The pace was uneven. In the early years of public reporting, the field gained about 0.8 percentage points per year. By the third phase of the analysis, it had dropped to about +0.1 per year. The easy gains had already been picked up. The same study showed a wide gap across measures: 

• Overall Rating of Hospital: +8.5 percentage points 
• Discharge Information: +7.3 percentage points 
• Nurse Communication: +6.5 percentage points 
• Doctor Communication: +0.8 percentage points 

There’s a counterpoint to all of this worth knowing. Bottom-decile hospitals improved more than other hospitals across all measures during the same period. That narrowed the performance distribution and pulled the cut-points between star tiers closer together. Part of why a 4-star is harder to hold today than it was in 2013 is that the rest of the field underneath you has compressed. 

1. Comparing Yourself to the Wrong Field

A national average combines academic medical centers, regional systems, rural hospitals, safety-net facilities, and critical-access hospitals into a single number. 

That works fine for broad national reporting. It doesn’t work as well for operational target-setting inside an actual hospital. 

The better comparison comes from hospitals that operate like yours. Similar service mix. Similar geography. Similar patient population. Similar payer structure. 

National averages can make some organizations look stronger than they are, and others look worse than they really are.

2. Geography Is Doing More Work Than People Realize

HCAHPS scores aren’t evenly distributed across the country. Recent research on regional drivers of patient satisfaction found persistent regional variation. The Midwest and parts of the Mountain West run higher on most HCAHPS composites than the Northeast or Southeast. 

Care quality isn’t uniformly better in the Midwest. The pattern exists because population demographics and how patients in different regions tend to answer survey questions interact with HCAHPS in ways the CMS patient-mix adjustment doesn’t fully wash out.

3. The Cut-Points Don’t Sit Still

Star ratings get assigned by comparing your scores to where the rest of the field sits in the current quarter. There’s no fixed historical line to run after. So, if your scores climb a couple of points and the national average climbs three, your public rating can fall. 

Last spring, I sat in a meeting where a hospital had hit every internal benchmark on its plan for the year, and the Care Compare star still dropped by one star on the next refresh. Nothing they did was wrong. The thresholds had changed during the same window. 

If we revisit the aforementioned CNO and her 78 on Nurse Communication. 

I had three questions for her. The first one was where 78 sat in the percentile distribution for that reporting period. The answer turned out to be below the median, somewhere between the 25th and 50th. 

The second was what her peer hospital’s number looked like at the same percentile. Nobody had built that comparison yet. We spent an hour the following week pulling the data. 

The third was about her trend over the last four quarters. Up about two points, but the national mean had moved up faster than that. 

By the time we wrapped that meeting, the 78 percent had meaning. Her hospital had improved by a couple of points over four quarters. But the national average had climbed faster, widening the gap between her and her peer set. 

That’s the kind of context a board can actually do something with. Without it, the 78 just sits there. 

The benchmark conversation is going to shift again over the next year. 

The current eight-measure public reporting structure is temporary. Three additional HCAHPS domain measures are expected to enter public reporting during the October 2026 Care Compare refresh. 

Some composites are also still sitting in transition. Care Transitions and Responsiveness of Hospital Staff are not currently displayed publicly during the redesigned survey rollout. 

Hospitals that built long-running improvement work around those measures should probably treat older scores as directional reference points for now, rather than assuming the methodology remained perfectly consistent beneath them. 

There’s another benchmark shift happening outside inpatient reporting, too. 

Beginning with the 2026 Overall Hospital Quality Star Rating refresh (released May 2026), five OAS CAHPS measures fold into the rating’s PX domain, reflecting care delivered in Hospital Outpatient Departments. For systems with large outpatient operations, that means more of their performance now feeds the same star rating leadership teams already watch. It’s a wider set of inputs behind the familiar one.

Read the Percentiles Before the Mean 

The national average gives you a quick snapshot. 

The percentiles tell you where the field actually spreads out. 

A hospital sitting at 78 percent on Nurse Communication looks very different depending on whether the 75th percentile sits at 80 or 86. 

That’s the difference between a modest operational gap and a major one. 

Build a Comparison Group That Looks Like You 

Most executives don’t really care how your hospital compares against every facility in the country. 

They care how you’re performing against hospitals competing in the same environment. 

Service mix matters. Geography matters. Payer mix matters. Bed count matters too. 

The peer group usually changes the conversation faster than the national average does. 

Track the Gap Across Multiple Quarters 

One quarter moves around more than people think. 

Four-quarter trends are usually where the real signal starts showing up. 

The chart I end up revisiting most often with leadership teams isn’t the benchmark itself. It’s the distance between the hospital and its peer group over time. 

That’s usually where you see whether improvement work is actually changing position in the field or just keeping pace with everyone else. 

What Is a Good HCAHPS Top-Box Score? 

A “good” HCAHPS top-box score is relative.  It depends on the measure, and the goal you have set . For Communication with Nurses in the July 2025 reporting period, the median sat at 80 percent, and the 75th percentile sat higher. The most useful benchmark is the percentile band for hospitals similar to yours in size, service mix, and geography.  

There isn’t a universal “good” score, and chasing one is the wrong starting point. A target depends on the measure, where your peer group sits, and — most importantly — the goal you’ve set and the why behind it.

A number only matters once it’s tied to what you’re actually trying to improve for patients. For example, Communication with Nurses in the July 2025 reporting period had a median top-box of 80 percent, with the 75th percentile higher still. But the most useful benchmark isn’t the national figure. It’s the percentile band for hospitals similar to yours in size, service mix, and geography, read against the goal you’re working toward. 

Where Do I Find the Most Recent National HCAHPS Averages? 

Two places. The HCAHPS Online Summary Analyses page is where you’ll find the national means and percentile distributions, refreshed each quarter. If you need to pull the data into a spreadsheet, the CMS Provider Data Catalog provides the same numbers as CSV downloads, plus state and hospital-level versions. 

How Often Are HCAHPS National Averages Updated? 

Quarterly, on the same cadence as the Care Compare refresh. Each release reflects four quarters of patient discharge data. 

Why Does Our Region’s HCAHPS Performance Differ from the National Average? 

It’s a real pattern that holds up in the data year after year. Patients in the Midwest tend to score their hospitals more generously than patients in the Northeast on most composites, and the difference isn’t about clinical care. Population demographics differ across regions, and patients from different parts of the country use survey scales differently. CMS’s patient-mix adjustment levels some of that out,but not all of it. That’s why the regional gap keeps showing up when researchers look at it directly. 

Are National HCAHPS Averages Adjusted for Hospital Size? 

No. They’re unadjusted means and percentiles across every participating hospital. Smaller hospitals tend to see more volatility due to smaller n-sizes , which is one reason their quarterly numbers move around more than larger systems’. 

The national average is useful. It just isn’t enough by itself. 

The hospitals that tend to use benchmark data well spend less time reacting to a quarterly number and more time watching the relationship between their organization, their peer group, and the broader field over time. 

Benchmark conversations become more productive once the national mean ceases to be the sole method of comparison. 

 NRC Health’s CAHPS solutions are built for the work that comes after the national mean.