Two hospitals in South Dakota were rated “below average” in 2026 based on a regular review of patient care and medical outcome benchmarks set by the federal government.

But those poor results were far from the norm, as most hospitals statewide received average or better grades in the annual Overall Hospital Quality Star Ratings determined by the U.S. Centers for Medicare & Medicaid Services (CMS).

The ratings range from 1 star on the low end to 5 stars at the top and are based on categories including mortality, safety of care, readmission, patient experiences and timely and effective care.

The two South Dakota hospitals rated 2 stars in 2026 were Avera St. Mary’s in Pierre and Huron Regional Medical Center. Both had some positive and negative findings in their overall reviews, but they had lower-than-average recommendation rates by patients.

Five hospitals received top 5-star marks in 2026, up from three last year.

Tim Rave, CEO of the South Dakota Association of Healthcare Organizations, called the ratings “an important benchmark” and added they are far from the only metric hospitals and the public should use to evaluate the quality of patient care.

“While the overall star rating provides helpful information for consumers, hospital leaders rely on much more detailed data to identify opportunities for improvement and ensure they are providing safe, high-quality care,” Rave said in an email to News Watch.

Here is a look at how each South Dakota hospital that was rated fared in 2026, with the 2025 Star Rating included in parentheses where applicable.

5 stars (much above average):

  • Avera Heart Hospital, Sioux Falls (5 stars in 2025)
  • Avera St. Benedict Health Center, Parkston (no rating in 2025)
  • Sanford USD Medical Center, Sioux Falls (4 stars in 2025)
  • VA Medical Center, Sioux Falls (5 stars in 2025)
  • VA Healthcare System, Sturgis (4 stars in 2025)

4 stars (above average):

  • Avera McKenna H/UMC, Sioux Falls (3 stars in 2025)
  • Avera Queen of Peace, Mitchell (no rating in 2025)
  • Avera St. Luke’s, Aberdeen (5 stars in 2025)
  • Brookings Health System, Brookings (4 stars in 2025)
  • Monument Health, Spearfish (no rating in 2025)
  • Sanford Medical Center, Aberdeen (4 stars in 2025)

3 stars (average):

  • Avera Sacred Heart, Yankton (4 stars in 2025)
  • Monument Health, Rapid City (4 stars in 2025)
  • Prairie Lakes Healthcare, Watertown (4 stars in 2025)

2 stars (below average):

  • Avera St. Mary’s, Pierre (3 stars in 2025)
  • Huron Regional MC, Huron (no rating in 2025)

1 star (much below average):

  • No South Dakota hospital at this rating

Cale Feller, director of corporate communications for Avera Health said the CMS ratings use data from as far back as 2021 and there is a slim margin between star rating levels.

“Avera’s commitment to deliver safe, effective and compassionate care remains steadfast,” Feller wrote to News Watch in an email.

Monument Health representatives said they have taken numerous steps toward improving patient care and outcomes at Rapid City Hospital, which raised its star rating from a 1 in 2023 to a 4 in 2025. The Rapid City hospital fell to a 3-star rating this year.

“Many of our quality outcomes remain strong and continue to improve,” Melissa Haught, director of communications at Monument Health, wrote to News Watch in an email.

Both Feller and Haught said their health systems have used the CMS ratings as motivation to improve, and that both systems took specific actions to improve patient care and potentially boost future ratings.

Destiny Price, chief operating officer at Huron Regional, said the independent hospital voluntarily entered into the CMS evaluation system last year.

“We recognized the value of being transparent to identify where we’re not hitting all the targets so we can start working on those things,” Price said.

For example, before the 2-star rating was announced, leaders of the 25-bed hospital recognized issues in sepsis care and took steps to minimize infections and improve outcomes, Price said.

Huron Regional has also created a multi-disciplinary team that meets daily with each hospitalized patient, added a chronic care nurse and community health worker, and has a renovated birthing center and a new robot to aid in orthopedic surgeries.

“The quality of care we deliver now is not reflected in the rating,” she said.

South Dakota News Watch is an independent nonprofit. Read, subscribe for free and donate at sdnewswatch.org. Contact content director Bart Pfankuch: 605-937-9398/bart.pfankuch@sdnewswatch.org.