Methodology
Core principle: We compare facilities only within their own state, using official federal data, with monthly updates and transparent math.
On this page
Data sources
We use only official U.S. government data. Every metric on this site comes from public federal datasets. We don't accept facility-submitted information, private surveys, or sponsored content.
Primary sources
- Centers for Medicare & Medicaid Services (CMS) — Hospital Compare, Nursing Home Compare, Provider of Services files, and related datasets
- Department of Health & Human Services (HHS) — Supplementary reporting when noted on specific report pages
Specific datasets vary by metric. For example, emergency room wait times come from CMS Hospital Compare data, while nursing home staffing comes from CMS Payroll-Based Journal (PBJ) reporting. Data release schedules differ, so some metrics may be 1-3 months behind real-time.
State-based comparisons (why we never compare across states)
Every comparison on this site happens within a single state. We never rank a California hospital against a Texas hospital, or a Florida nursing home against a Nebraska nursing home.
Why state-level only?
States have fundamentally different healthcare systems, patient populations, regulations, and economic conditions. A "fast" emergency room in rural Wyoming serves different patient volumes than a "fast" emergency room in urban New York. A nursing home in California operates under different staffing requirements than one in Alabama.
National averages hide these differences and create unfair comparisons. State-level comparisons give you context that actually matters: how does this facility perform compared to the alternatives you actually have where you live or where your family member receives care?
What we report
For each facility metric, you'll see:
- Delta vs. state median: How far above or below the state median this facility performs, expressed as a percentage (e.g., "15% faster than the California average")
- Rank: Position among in-state peers (e.g., "#12 of 89 Nebraska nursing homes")
- Percentile: What percentage of in-state facilities this facility outperforms (e.g., "Better than 78% of California hospitals")
- Nearby alternatives: A short list of in-state facilities with stronger results for the metric in question, when available
Emergency room wait times (hospitals)
What it measures
Definition: Median time in minutes from arrival at the emergency department to being seen by a qualified medical professional (doctor, physician assistant, or nurse practitioner).
Direction: Lower is better. Shorter wait times mean faster access to care in emergencies.
How we present it
On hospital pages, you'll see:
- The facility's median ER wait time
- How it compares to the state median (e.g., "18% faster than the Texas average")
- State rank and percentile
- A list of nearby faster alternatives (hospitals in the same state with shorter wait times)
Why this metric matters: In emergencies, every minute counts. While ER wait time doesn't tell you everything about a hospital's quality, it's often the most visible and immediate factor when families are choosing where to go for urgent care.
What it doesn't measure
This metric measures time to initial assessment, not total time in the ER or time to treatment completion. It also doesn't account for case severity — hospitals treating more critical patients may have longer wait times for less urgent cases.
Staffing levels (nursing homes)
What it measures
Nursing home pages show two staffing metrics, both measured in hours per resident per day (HPRD):
Registered Nurse (RN) hours per resident day
Definition: Average daily hours of RN care each resident receives. Direction: Higher is better. RNs are the most highly trained nursing staff and handle complex medical care, medication management, and health assessments.
Total nursing hours per resident day
Definition: Combined daily hours from all nursing staff (RNs, Licensed Practical Nurses/LPNs, and Certified Nursing Assistants/CNAs). Direction: Higher is better. Total staffing indicates overall hands-on care availability.
Why we show both
RN staffing and total staffing can move independently. A nursing home might have high total staffing but low RN staffing (meaning more CNAs, fewer RNs). Or it might have strong RN staffing but lower overall staffing. Both matter, so we show both.
Why RN staffing matters most: Research consistently links higher RN staffing to better health outcomes, fewer medication errors, and better management of chronic conditions. When families ask "will my parent get good care here?" RN staffing is often the strongest predictor.
How we present it
On nursing home pages, you'll see (for each metric):
- The facility's staffing level in HPRD
- How it compares to the state median
- State rank and percentile
- Nearby better-staffed alternatives when available
Above / Average / Below badges
To make facility pages scannable, we use simple badges that summarize how a facility compares to its state median:
- Above average — Performing better than the state median by more than 5% in the favorable direction
- Average — Within ±5% of the state median
- Below average — Performing worse than the state median by more than 5% in the unfavorable direction
Direction matters. "Better" depends on the metric. For emergency room wait times, lower is better (faster care). For nursing home staffing, higher is better (more care hours). We adjust badge logic accordingly.
Small peer groups (fewer than 20 facilities)
When a state has very few facilities reporting a metric (fewer than 20), we use simple thirds instead of the ±5% band:
- Top third = Above average
- Middle third = Average
- Bottom third = Below average
This prevents over-precision when sample sizes are too small for meaningful percentage deltas.
Overall scores
Where shown, overall scores are state-normalized composite measures designed to help families scan quickly. They combine the relevant metrics on the page (ER wait times and safety indicators for hospitals; RN staffing and quality ratings for nursing homes) into a single 0-100 scale.
How to use them: Overall scores are useful for quick comparisons, but they're intentionally simplified. Always review the individual metric details before making decisions. A facility might have a moderate overall score but excel in the specific metric you care most about (like RN staffing or ER speed).
State-normalized calculation: Scores are calculated using state-level distributions, not national distributions. A score of 75 in California means "75th percentile among California facilities," not "75th percentile nationally."
Refresh schedule & transparency
How often we update
Target schedule: We refresh the entire site monthly with the latest available federal data. Updates typically happen in the first week of each month.
Data lag: Federal datasets release on different schedules. Some metrics update monthly, others quarterly. The data you see may be 1-3 months behind real-time depending on when the source agency released it.
How you know when data was last updated
Every page footer shows "Last updated: November 2025" — this is the date of our most recent site build using the latest available data.
Change notes & corrections
- Material changes (methodology updates, source changes, major corrections) are summarized in our project changelog
- Facility-level corrections flow into the next monthly refresh (or sooner for critical issues)
- See our Corrections policy for how to report errors
Questions about our methodology?
We're happy to explain our approach in more detail. Email [email protected] with your question.