Spotsylvania Regional Medical Center

Hospital in Fredericksburg, VA, Medicare certification number 490141. CMS publishes 58 quality measures for it.

Medicare certification

Provider of Services

CCN: 490141The number CMS certifies the facility under, not a provider identifier
Status: Active
Provider type: Hospital – Short-term
Listed by Care Compare as: Acute Care Hospitals
Ownership: Proprietary
Control type: Private (for profit)
Participating since: Jun 15, 2010
Last certification: Oct 27, 2011
Beds: 126
Overall star rating: 3 of 5Care Compare
Address: 4600 Spotsylvania Parkway
Fredericksburg, VA 22408
(540) 498-4000

NPI records for this facility 1

Spotsylvania Medical Center Inc
- General Acute Care Hospital
- Fredericksburg, VA
- NPI 1376876664
Medicare enrollment

Patient survey (HCAHPS) 9

Medicare Care Compare

Cleanliness - star rating Worse3 of 5
- State average 3.72 (computed here)
- National average 3.44 (computed here)
- Period from 10/01/2024
Communication about medicines - star rating Worse1 of 5
- State average 2.85 (computed here)
- National average 2.71 (computed here)
- Period from 10/01/2024
Discharge information - star rating Worse1 of 5
- State average 3.37 (computed here)
- National average 3.31 (computed here)
- Period from 10/01/2024
Doctor communication - star rating Worse2 of 5
- State average 3.52 (computed here)
- National average 3.12 (computed here)
- Period from 10/01/2024
Nurse communication - star rating Worse2 of 5
- State average 3.82 (computed here)
- National average 3.43 (computed here)
- Period from 10/01/2024
Overall hospital rating - star rating Worse2 of 5
- State average 3.54 (computed here)
- National average 3.29 (computed here)
- Period from 10/01/2024
Quietness - star rating Worse3 of 5
- State average 3.41 (computed here)
- National average 3.27 (computed here)
- Period from 10/01/2024
Recommend hospital - star rating Worse2 of 5
- State average 3.8 (computed here)
- National average 3.64 (computed here)
- Period from 10/01/2024
Summary star rating Worse2 of 5
- State average 3.48 (computed here)
- National average 3.27 (computed here)
- Period from 10/01/2024

Complications and deaths 17

Medicare Care Compare

Abdominopelvic accidental puncture or laceration rate As expected1.25
- State average 1.11 (computed here)
- National average 1.06
- No different than the national rate
- 407 patients
- Period from 07/01/2022
CMS Medicare PSI 90: Patient safety and adverse events composite As expected0.84
- State average 0.97 (computed here)
- National average 1
- No different than the national value
- Period from 07/01/2022
Death rate for COPD patients As expected8.3
- State average 8.63 (computed here)
- National average 8.6
- No different than the national rate
- 109 patients
- Period from 07/01/2022
Death rate for heart attack patients As expected12.7
- State average 11.72 (computed here)
- National average 11.9
- No different than the national rate
- 122 patients
- Period from 07/01/2022
Death rate for heart failure patients As expected9.7
- State average 10.98 (computed here)
- National average 11.1
- No different than the national rate
- 240 patients
- Period from 07/01/2022
Death rate for pneumonia patients As expected15.9
- State average 15.17 (computed here)
- National average 15.2
- No different than the national rate
- 258 patients
- Period from 07/01/2022
Death rate for stroke patients As expected10.8
- State average 11.65 (computed here)
- National average 11.9
- No different than the national rate
- 132 patients
- Period from 07/01/2023
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Rate As expected3.9
- State average 3.7 (computed here)
- National average 3.9
- No different than the national rate
- 1,467 patients
- Period from 07/01/2024
Iatrogenic pneumothorax rate As expected0.31
- State average 0.2 (computed here)
- National average 0.21
- No different than the national rate
- 3,335 patients
- Period from 07/01/2022
In-hospital fall-associated fracture rate As expected0.29
- State average 0.26 (computed here)
- National average 0.27
- No different than the national rate
- 3,314 patients
- Period from 07/01/2022
Perioperative pulmonary embolism or deep vein thrombosis rate As expected2.89
- State average 3.36 (computed here)
- National average 3.52
- No different than the national rate
- 560 patients
- Period from 07/01/2022
Postoperative acute kidney injury requiring dialysis rate As expected1.61
- State average 1.78 (computed here)
- National average 1.67
- No different than the national rate
- 204 patients
- Period from 07/01/2022
Postoperative hemorrhage or hematoma rate As expected2.09
- State average 2.34 (computed here)
- National average 2.34
- No different than the national rate
- 547 patients
- Period from 07/01/2022
Postoperative respiratory failure rate As expected7.66
- State average 9.5 (computed here)
- National average 9.42
- No different than the national rate
- 214 patients
- Period from 07/01/2022
Postoperative sepsis rate As expected4.79
- State average 5.55 (computed here)
- National average 5.27
- No different than the national rate
- 203 patients
- Period from 07/01/2022
Postoperative wound dehiscence rate As expected1.73
- State average 1.77 (computed here)
- National average 1.77
- No different than the national rate
- 107 patients
- Period from 07/01/2022
Pressure ulcer rate As expected0.31
- State average 0.51 (computed here)
- National average 0.63
- No different than the national rate
- 2,284 patients
- Period from 07/01/2022

Measures CMS does not publish for this facility (3)

Death rate among surgical inpatients with serious treatable complications — 1
Death rate for CABG surgery patients — 5
Rate of complications for hip/knee replacement patients — 1

Infections 3

Medicare Care Compare

Catheter Associated Urinary Tract Infections (ICU + select Wards) As expected0
- State average 0.37
- National average 1
- No different than national benchmark
- Period from 10/01/2024
Central Line Associated Bloodstream Infection (ICU + select Wards) As expected0.64
- State average 0.5
- National average 1
- No different than national benchmark
- Period from 10/01/2024
Clostridium Difficile (C.Diff) Better0.19
- State average 0.27
- National average 1
- Better than the national benchmark
- Period from 10/01/2024

Measures CMS does not publish for this facility (3)

MRSA Bacteremia — 13
SSI - Abdominal Hysterectomy — 13
SSI - Colon Surgery — 13

Outpatient imaging 2

Medicare Care Compare

Abdomen CT Use of Contrast Material 0.5
- State average 4.51 (computed here)
- National average 5.83 (computed here)
- Period from 07/01/2024
Breast Cancer Screening Recall Rates 7.5
- State average 6.41 (computed here)
- National average 8.08 (computed here)
- Period from 07/01/2024

Spending per patient 1

Medicare Care Compare

Medicare hospital spending per patient (Medicare Spending per Beneficiary) 0.98
- State average 0.97
- National average 0.99 (computed here)
- Period from 01/01/2024

Timely and effective care 17

Medicare Care Compare

Antithrombotic Therapy by End of Hospital Day 2 95
- State average 96.03 (computed here)
- National average 92.79 (computed here)
- 104 patients
- Period from 01/01/2024
Appropriate care for severe sepsis and septic shock 49
- State average 67
- National average 65
- 128 patients
- Period from 10/01/2024
Average (median) time all patients spent in the emergency department before leaving from the visit, including psychiatric/mental health patients and patients who were transferred to another facility. A lower number of minutes is better 122
- State average 166
- National average 168
- 441 patients
- Period from 10/01/2024
Average (median) time patients spent in the emergency department before being transferred to another facility. A lower number of minutes is better 330
- State average 348
- National average 287
- 15 patients
- Period from 10/01/2024
Average (median) time patients spent in the emergency department before leaving from the visit, excluding patients transferred to another facility or psychiatric care/mental health patients. A lower number of minutes is better 120
- State average 161
- National average 162
- 415 patients
- Period from 10/01/2024
Average (median) time psychiatric/mental health patients spent in the emergency department before leaving from the visit. A lower number of minutes is better 155
- State average 242
- National average 257
- 12 patients
- Period from 10/01/2024
Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients 88
- State average 91
- National average 93
- 64 patients
- Period from 01/01/2024
Head CT results 93
- State average 69
- National average 69
- 15 patients
- Period from 10/01/2024
Healthcare workers given influenza vaccination 50
- State average 87
- National average 78
- 976 patients
- Period from 10/01/2024
Intensive Care Unit Venous Thromboembolism Prophylaxis 97
- State average 92.69 (computed here)
- National average 93.49 (computed here)
- 617 patients
- Period from 01/01/2024
Left before being seen 1
- State average 2
- National average 2
- 54,657 patients
- Period from 01/01/2024
Safe Use of Opioids - Concurrent Prescribing 16
- State average 13
- National average 15
- 1,913 patients
- Period from 01/01/2024
Septic Shock 3-Hour Bundle 49
- State average 73
- National average 73
- 39 patients
- Period from 10/01/2024
Septic Shock 6-Hour Bundle 81
- State average 87
- National average 87
- 16 patients
- Period from 10/01/2024
Severe Sepsis 3-Hour Bundle 70
- State average 83
- National average 81
- 128 patients
- Period from 10/01/2024
Severe Sepsis 6-Hour Bundle 94
- State average 93
- National average 93
- 66 patients
- Period from 10/01/2024
Venous Thromboembolism Prophylaxis 93
- State average 89.73 (computed here)
- National average 82.23 (computed here)
- 3,386 patients
- Period from 01/01/2024

Measures CMS does not publish for this facility (13)

Anticoagulation Therapy for Atrial Fibrillation/Flutter — 5
Discharged on Antithrombotic Therapy — 5
Emergency department volume — high
Global Malnutrition Composite Score — 5
Global Malnutrition Composite Score: Malnutrition Diagnosis Documented — 5
Global Malnutrition Composite Score: Malnutrition Risk Screening — 5
Global Malnutrition Composite Score: Nutrition Assessment — 5
Global Malnutrition Composite Score: Nutritional Care Plan — 5
Hospital Harm - Opioid Related Adverse Events — 5
Hospital Harm - Severe Hyperglycemia — 5
Hospital Harm - Severe Hypoglycemia — 5
Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery — 5
ST-Segment Elevation Myocardial Infarction (STEMI) — 1

Unplanned visits 9

Medicare Care Compare

Acute Myocardial Infarction (AMI) 30-Day Readmission Rate As expected15.5
- State average 14.25 (computed here)
- National average 14.4
- No different than the national rate
- 119 patients
- Period from 07/01/2023
Heart failure (HF) 30-Day Readmission Rate As expected23.2
- State average 21.23 (computed here)
- National average 21.3
- No different than the national rate
- 377 patients
- Period from 07/01/2023
Hospital return days for heart attack patients 22.1
- State average 0.82 (computed here)
- National average 6.71 (computed here)
- Average days per 100 discharges
- 114 patients
- Period from 07/01/2022
Hospital return days for heart failure patients 11.5
- State average -3.12 (computed here)
- National average 4.02 (computed here)
- Average days per 100 discharges
- 309 patients
- Period from 07/01/2022
Hospital return days for pneumonia patients 43.5
- State average 4.9 (computed here)
- National average 5.65 (computed here)
- More days than average per 100 discharges
- 261 patients
- Period from 07/01/2022
Pneumonia (PN) 30-Day Readmission Rate As expected19.3
- State average 17.36 (computed here)
- National average 17.3
- No different than the national rate
- 326 patients
- Period from 07/01/2023
Rate of readmission for chronic obstructive pulmonary disease (COPD) patients As expected20.8
- State average 19.7 (computed here)
- National average 20
- No different than the national rate
- 153 patients
- Period from 07/01/2023
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies) As expected13
- State average 12.88 (computed here)
- National average 13
- No different than the national rate
- 358 patients
- Period from 01/01/2022
Ratio of unplanned hospital visits after hospital outpatient surgery As expected1
- State average 1.02 (computed here)
- National average 1.01 (computed here)
- No different than expected
- 152 patients
- Period from 01/01/2024

Measures CMS does not publish for this facility (5)

Hybrid Hospital-Wide All-Cause Readmission Measure (HWR) — 4
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapy — 5
Rate of inpatient admissions for patients receiving outpatient chemotherapy — 5
Rate of readmission after hip/knee replacement — 1
Rate of readmission for CABG — 5

Sources for this page

Provider of Services: the certification, provider type, beds and status.
Medicare Care Compare: the star rating and every measure on this page, with the state and national rates CMS publishes beside them.
NPPES NPI Registry: the NPI records connected to this certification.

Better and worse are CMS's own comparison with the national rate, not ours: for most measures a low score is the good one (deaths, infections) and for others a high one is, so measures where CMS states no comparison are left uncoloured. The exception is star ratings, which are read against the national average here. Quality measures are published by CMS and are not adjusted or re-scored here. Averages marked “computed here” are the mean of every facility reporting that measure, worked out by NPIMap because CMS publishes no comparison for it. Confirm anything you rely on at Medicare Care Compare.