Quality-Adjusted Cost Score (QACS)
The cheapest option is not always the best option. QACS combines price, quality, patient experience, and outcomes into a single composite score so you can find true value.
Why Quality-Adjusted Scoring
Price transparency data reveals enormous variation in what hospitals charge for the same procedure. But price alone tells an incomplete story. A facility that charges 20% more but has significantly better outcomes, lower readmission rates, and higher patient satisfaction may deliver better value per dollar. QACS quantifies this trade-off.
The score is designed to penalize facilities that are expensive without corresponding quality advantages, and to reward facilities that deliver strong outcomes at fair prices. A high-priced academic medical center with top-tier outcomes will score well; a high-priced community hospital with average outcomes will not.
The Four Dimensions
QACS is a weighted composite of four normalized dimensions:
Price Rank
40% weightWhere the facility falls in the regional price distribution for the specific procedure. A facility at P25 (cheaper than 75% of peers) receives a higher price rank score than one at P75. The rank is computed within the user's search radius to ensure geographic comparability. We use the combined facility + professional fee total for this calculation.
CMS Star Rating
30% weightCMS assigns each Medicare-certified hospital an Overall Hospital Quality Star Rating from 1 to 5 stars, based on over 100 quality measures across seven domains: mortality, safety of care, readmission, patient experience, effectiveness of care, timeliness of care, and efficient use of medical imaging. We normalize the 1-5 rating to a 0-100 scale. Hospitals without a star rating receive the category median to avoid penalizing newer or specialized facilities.
Patient Experience
20% weightDerived from HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey data. HCAHPS is a standardized, publicly reported survey of patients' perspectives on hospital care, administered to a random sample of adult inpatients between 48 hours and 6 weeks after discharge. We use the composite score across communication, responsiveness, cleanliness, discharge information, and overall hospital rating. The survey is CMS-mandated -- every participating hospital must collect and report these scores.
Clinical Outcomes
10% weightRisk-adjusted complication and readmission rates from CMS Hospital Compare. For procedure-specific outcomes, we use the procedure-level complication rate where available (e.g., hip/knee replacement complication rates). For procedures without specific outcome measures, we use the hospital-wide 30-day readmission rate as a proxy. Risk adjustment controls for patient age, severity, and comorbidities so that hospitals treating sicker patients are not unfairly penalized.
Score Calculation
Each dimension is normalized to a 0-100 scale. The QACS composite is computed as:
QACS = (Price Rank x 0.40) + (CMS Stars x 0.30) + (Patient Experience x 0.20) + (Clinical Outcomes x 0.10)The resulting score ranges from 0 to 100, where 100 represents the best possible combination of low price and high quality. In practice, most facilities score between 35 and 85. Scores above 70 indicate strong value; scores below 40 suggest the facility is either overpriced relative to quality or has below-average outcomes.
The weighting reflects research showing that price variation is the largest driver of value differences in healthcare, while quality differences between most accredited hospitals are narrower. Users who prioritize quality over cost can adjust weights through the API's weights parameter.
Handling Missing Data
Not all facilities have complete data across all four dimensions. Critical access hospitals, specialty facilities, and newer hospitals may lack star ratings or HCAHPS data. When a dimension is missing, we impute the regional median for that dimension and flag the score as "partial" in the API response. The user interface displays which dimensions contributed real data versus imputed values, ensuring full transparency about confidence in the score.
Related API Endpoints
/v1/compare/v1/facilities/:id/v1/report