How Rural Hospitals Protect CMS Star Ratings During Major Facility Expansions Using Patient-Reported Outcomes
- SolvEdge
- Dec 30, 2025
- 5 mins read
Rural hospitals punch above their weight in quality care, often serving higher-risk patients with fewer resources. Yet with 46% operating on negative margins as of late 2025, CMS star ratings are critical for survival—driving Medicare revenue, patient choice, and community support.
Major expansions are essential for growth but pose real threats to these ratings. Citizens Memorial Hospital (CMH) in Bolivar, Missouri—a consistent 4-star CMS performer with a Leapfrog “A” safety grade—is midway through its $100+ million south tower project: a 117,000 sq ft addition set to open in 2026, expanding emergency, ICU, and inpatient capacity.
CMH and similar rural leaders protect ratings during construction by leveraging patient-reported outcomes (PROMs) for real-time insights and proactive care.
The Hidden Quality Risk During Rural Hospital Expansion
Even high-performing facilities face disruptions:
Increased ED boarding and delays in timely care.
HCAHPS declines from noise, rerouting, and access challenges.
Readmission spikes from transitional workflow gaps.
These hit CMS domains hard: Patient Experience (22% weight), Readmissions (22%), and Safety/Timely Care.
With CMS TEAM bundles mandatory in 2026 (including LEJR and spine), rural hospitals must safeguard stars while preparing for episode accountability.
Why PROMs Are Essential for Protecting Stars Amid Construction
PROMs provide continuous patient feedback on function, pain, and recovery—bridging gaps when processes falter.
Rural systems using PROMs during expansions maintain visibility into outcomes, enabling early interventions that prevent rating drops.
3 Rural Hospitals That Sustained or Improved Stars During Major Projects
| Hospital Type / Location | Pre-Expansion Rating | PROMs Strategy | Results During / After Expansion |
|---|---|---|---|
| Missouri Rural System (e.g., similar to CMH) | 4 Stars | Automated digital PROMs + discharge pathways | Sustained 4 stars; readmissions ↓15–20% |
| Midwest Critical Access | 3 Stars | Episode PROMs tied to ortho / surgical growth | Improved to 4 stars; HCAHPS ↑18–25 points |
| Regional Rural Network | 4 Stars | Real-time PROMs for risk monitoring | Maintained rating; LOS ↓1–1.2 days |
These examples show PROMs counter construction disruptions effectively.
5 PROMs Strategies Rural Hospitals Deploy During Expansion
Digital Discharge Pathways Automated PROMs check-ins catch risks early, reducing readmissions 18–22%.
Real-Time Recovery Tracking Frequent surveys predict complications, supporting timely interventions.
Acuity-Linked Throughput PROM trends inform staffing and bed management amid phasing.
Construction-Phase Analytics Dashboards isolate impacts on HCAHPS and safety for targeted fixes.
TEAM Bundle Preparation Build PROM infrastructure now for 2026 mandatory compliance and savings.
Rural Hospital Checklist: Safeguard Stars During Your Expansion
Roll out automated PROMs for high-volume services (ortho, ED discharges)
- Integrate recovery data with throughput tools
Monitor phase-specific effects on key metrics
Prepare episode analytics for CMS TEAM 2026
Use outcomes data to demonstrate ROI to board and donors
Ready to Protect Your CMS Stars During Expansion?
Projects like CMH’s south tower are investments in the future—but they don’t have to jeopardize current quality standing.
Southwest Missouri hospitals: Request your free PROMs Maturity Assessment and expansion readiness review today.