Acute Care - Veterans AdministrationVeterans Health Admin.Emergency services

VA N. INDIANA HEALTHCARE SYSTEM

1700 E. 38TH STREET, MARION, IN, 46953 · (765) 674-3321

CMS facility ID 15004F

CMS overall rating
5 / 5
Highest
Measures reported
70
across 3 measure groups
Patient survey rows
68
HCAHPS responses

How this hospital compares, by group

Counts published by CMS: how many of its measures were better, no different, or worse than the national average.

Measure group comparison counts
GroupBetterNo differentWorseMeasures reported
Mortality0303
Safety————
Readmission2204

"Compared to National" labels are published by CMS itself. This site displays them as issued and does not derive or re-rank them.

Healthcare-associated infections

Infections patients acquired while in hospital. 36 measures.

MeasureCompared to nationalScore95% intervalCasesPeriod
Catheter Associated Urinary Tract Infections (ICU + select Wards)—Not reported——2024-10-01 → 2025-09-30
Catheter Associated Urinary Tract Infections (ICU + select Wards): Lower Confidence Limit—Not reported——2024-10-01 → 2025-09-30
Catheter Associated Urinary Tract Infections (ICU + select Wards): Number of Urinary Catheter Days—Not reported——2024-10-01 → 2025-09-30
Catheter Associated Urinary Tract Infections (ICU + select Wards): Observed Cases—Not reported——2024-10-01 → 2025-09-30
Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases—Not reported——2024-10-01 → 2025-09-30
Catheter Associated Urinary Tract Infections (ICU + select Wards): Upper Confidence Limit—Not reported——2024-10-01 → 2025-09-30
Central Line Associated Bloodstream Infection (ICU + select Wards)—Not reported——2024-10-01 → 2025-09-30
Central Line Associated Bloodstream Infection (ICU + select Wards): Lower Confidence Limit—Not reported——2024-10-01 → 2025-09-30
Central Line Associated Bloodstream Infection (ICU + select Wards): Observed Cases—Not reported——2024-10-01 → 2025-09-30
Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases—Not reported——2024-10-01 → 2025-09-30
Central Line Associated Bloodstream Infection (ICU + select Wards): Upper Confidence Limit—Not reported——2024-10-01 → 2025-09-30
Central Line Associated Bloodstream Infection: Number of Device Days—Not reported——2024-10-01 → 2025-09-30
Clostridium Difficile (C.Diff)—Not reported——2024-10-01 → 2025-09-30
Clostridium Difficile (C.Diff): Lower Confidence Limit—Not reported——2024-10-01 → 2025-09-30
Clostridium Difficile (C.Diff): Observed Cases—Not reported——2024-10-01 → 2025-09-30
Clostridium Difficile (C.Diff): Patient Days—Not reported——2024-10-01 → 2025-09-30
Clostridium Difficile (C.Diff): Predicted Cases—Not reported——2024-10-01 → 2025-09-30
Clostridium Difficile (C.Diff): Upper Confidence Limit—Not reported——2024-10-01 → 2025-09-30
MRSA Bacteremia—Not reported——2024-10-01 → 2025-09-30
MRSA Bacteremia: Lower Confidence Limit—Not reported——2024-10-01 → 2025-09-30
MRSA Bacteremia: Observed Cases—Not reported——2024-10-01 → 2025-09-30
MRSA Bacteremia: Patient Days—Not reported——2024-10-01 → 2025-09-30
MRSA Bacteremia: Predicted Cases—Not reported——2024-10-01 → 2025-09-30
MRSA Bacteremia: Upper Confidence Limit—Not reported——2024-10-01 → 2025-09-30
SSI - Abdominal Hysterectomy—Not reported——2024-10-01 → 2025-09-30
SSI - Abdominal Hysterectomy: Lower Confidence Limit—Not reported——2024-10-01 → 2025-09-30
SSI - Abdominal Hysterectomy: Number of Procedures—Not reported——2024-10-01 → 2025-09-30
SSI - Abdominal Hysterectomy: Observed Cases—Not reported——2024-10-01 → 2025-09-30
SSI - Abdominal Hysterectomy: Predicted Cases—Not reported——2024-10-01 → 2025-09-30
SSI - Abdominal Hysterectomy: Upper Confidence Limit—Not reported——2024-10-01 → 2025-09-30
SSI - Colon Surgery—Not reported——2024-10-01 → 2025-09-30
SSI - Colon Surgery: Lower Confidence Limit—Not reported——2024-10-01 → 2025-09-30
SSI - Colon Surgery: Number of Procedures—Not reported——2024-10-01 → 2025-09-30
SSI - Colon Surgery: Observed Cases—Not reported——2024-10-01 → 2025-09-30
SSI - Colon Surgery: Predicted Cases—Not reported——2024-10-01 → 2025-09-30
SSI - Colon Surgery: Upper Confidence Limit—Not reported——2024-10-01 → 2025-09-30

Complications and deaths

Rates of death and serious complications for common conditions, compared with the national average. 20 measures.

MeasureCompared to nationalScore95% intervalCasesPeriod
Abdominopelvic accidental puncture or laceration rate—Not reported——2022-07-01 → 2024-06-30
CMS Medicare PSI 90: Patient safety and adverse events composite—Not reported——2022-07-01 → 2024-06-30
Death rate among surgical inpatients with serious treatable complications—Not reported——2022-07-01 → 2024-06-30
Death rate for CABG surgery patients—Not reported——2022-07-01 → 2025-06-30
Death rate for COPD patientsNo different from national8.14.9 – 13852022-07-01 → 2025-06-30
Death rate for heart attack patientsNumber of Cases Too SmallNot reported——2022-07-01 → 2025-06-30
Death rate for heart failure patientsNo different from national8.85.7 – 13.61462022-07-01 → 2025-06-30
Death rate for pneumonia patientsNo different from national11.37.7 – 16.31172022-07-01 → 2025-06-30
Death rate for stroke patients—Not reported——2023-07-01 → 2025-06-30
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateNo different from national3.93 – 4.93572024-07-01 → 2025-06-30
Iatrogenic pneumothorax rate—Not reported——2022-07-01 → 2024-06-30
In-hospital fall-associated fracture rate—Not reported——2022-07-01 → 2024-06-30
Perioperative pulmonary embolism or deep vein thrombosis rate—Not reported——2022-07-01 → 2024-06-30
Postoperative acute kidney injury requiring dialysis rate—Not reported——2022-07-01 → 2024-06-30
Postoperative hemorrhage or hematoma rate—Not reported——2022-07-01 → 2024-06-30
Postoperative respiratory failure rate—Not reported——2022-07-01 → 2024-06-30
Postoperative sepsis rate—Not reported——2022-07-01 → 2024-06-30
Postoperative wound dehiscence rate—Not reported——2022-07-01 → 2024-06-30
Pressure ulcer rate—Not reported——2022-07-01 → 2024-06-30
Rate of complications for hip/knee replacement patients—Not reported——2023-04-01 → 2025-03-31

Unplanned hospital visits

How often patients came back to hospital unexpectedly after discharge. 14 measures.

MeasureCompared to nationalScore95% intervalCasesPeriod
Acute Myocardial Infarction (AMI) 30-Day Readmission RateNumber of Cases Too SmallNot reported——2023-07-01 → 2025-06-30
Heart failure (HF) 30-Day Readmission RateNo different from national18.815.5 – 22.21052023-07-01 → 2025-06-30
Hospital return days for heart attack patientsNumber of Cases Too SmallNot reported——2022-07-01 → 2025-06-30
Hospital return days for heart failure patientsFewer Days Than Average per 100 Discharges-74.9-92.3 – -50.81612022-07-01 → 2025-06-30
Hospital return days for pneumonia patientsAverage Days per 100 Discharges-3.7-31 – 32.31312022-07-01 → 2025-06-30
Hybrid Hospital-Wide All-Cause Readmission Measure (HWR)—Not reported——2024-07-01 → 2025-06-30
Pneumonia (PN) 30-Day Readmission RateNo different from national17.214.4 – 20.7862023-07-01 → 2025-06-30
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapy—Not reported——2024-01-01 → 2024-12-31
Rate of inpatient admissions for patients receiving outpatient chemotherapy—Not reported——2024-01-01 → 2024-12-31
Rate of readmission after hip/knee replacement—Not reported——2023-07-01 → 2025-06-30
Rate of readmission for CABG—Not reported——2023-07-01 → 2025-06-30
Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsNo different from national19.916.5 – 23.9582023-07-01 → 2025-06-30
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)—Not reported——2022-01-01 → 2024-12-31
Ratio of unplanned hospital visits after hospital outpatient surgery—Not reported——2024-01-01 → 2024-12-31

Score units differ between measures (rates, ratios, and Medicare dollars per beneficiary). Each measure is shown with its own name and reporting period; do not compare scores across measures.

Patient experience (HCAHPS)

Survey responses from patients, as published by CMS. Star ratings are 1–5; a blank means CMS withheld it.

Patients who reported that their room and bathroom were "Always" clean

Not rated
Room was "always" clean80%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their room and bathroom were "Sometimes" or "Never" clean

Not rated
Room was "sometimes" or "never" clean5%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their room and bathroom were "Usually" clean

Not rated
Room was "usually" clean15%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Cleanliness - linear mean score

Not rated

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Cleanliness - star rating

4 / 5 — Rating 4 of 5

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Always" communicated well

Not rated
Nurses "always" communicated well82%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Nurse communication - linear mean score

Not rated

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Sometimes" or "Never" communicated well

Not rated
Nurses "sometimes" or "never" communicated well3%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Nurse communication - star rating

4 / 5 — Rating 4 of 5

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Usually" communicated well

Not rated
Nurses "usually" communicated well15%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Always" communicated well

Not rated
Doctors "always" communicated well80%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Doctor communication - linear mean score

Not rated

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Sometimes" or "Never" communicated well

Not rated
Doctors "sometimes" or "never" communicated well4%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Doctor communication - star rating

4 / 5 — Rating 4 of 5

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Usually" communicated well

Not rated
Doctors "usually" communicated well16%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that staff "Always" explained about medicines before giving it to them

Not rated
Staff "always" explained69%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Communication about medicines - linear mean score

Not rated

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that staff "Sometimes" or "Never" explained about medicines before giving it to them

Not rated
Staff "sometimes" or "never" explained14%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Communication about medicines - star rating

4 / 5 — Rating 4 of 5

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that staff "Usually" explained about medicines before giving it to them

Not rated
Staff "usually" explained17%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Discharge information - linear mean score

Not rated

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that NO, they were not given information about what to do during their recovery at home

Not rated
No, staff "did not" give patients this information9%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Discharge information - star rating

5 / 5 — Highest

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that YES, they were given information about what to do during their recovery at home

Not rated
Yes, staff "did" give patients this information91%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that NO, they did not discuss whether they would need help after discharge

Not rated
No, staff "did not" give patients information about help after discharge11%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that YES, they did discuss whether they would need help after discharge

Not rated
Yes, staff "did" give patients information about help after discharge89%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Always" explained things in a way they could understand

Not rated
Doctors "always" explained things so they could understand76%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Sometimes" or "Never" explained things in a way they could understand

Not rated
Doctors "sometimes" or "never" explained things so they could understand6%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Usually" explained things in a way they could understand

Not rated
Doctors "usually" explained things so they could understand18%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Always" listened carefully to them

Not rated
Doctors "always" listened carefully80%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Sometimes" or "Never" listened carefully to them

Not rated
Doctors "sometimes" or "never" listened carefully5%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Usually" listened carefully to them

Not rated
Doctors "usually" listened carefully15%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Always" treated them with courtesy and respect

Not rated
Doctors "always" treated them with courtesy and respect86%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Sometimes" or "Never" treated them with courtesy and respect

Not rated
Doctors "sometimes" or "never" treated them with courtesy and respect2%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their doctors "Usually" treated them with courtesy and respect

Not rated
Doctors "usually" treated them with courtesy and respect12%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who gave their hospital a rating of 6 or lower on a scale from 0 (lowest) to 10 (highest)

Not rated
Patients who gave a rating of "6" or lower (low)7%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who gave their hospital a rating of 7 or 8 on a scale from 0 (lowest) to 10 (highest)

Not rated
Patients who gave a rating of "7" or "8" (medium)13%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)

Not rated
Patients who gave a rating of "9" or "10" (high)80%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Overall hospital rating - linear mean score

Not rated

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Overall hospital rating - star rating

4 / 5 — Rating 4 of 5

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that when receiving new medication the staff "Always" communicated what the medication was for

Not rated
Staff "always" explained new medications78%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that when receiving new medication the staff "Sometimes" or "Never" communicated what the medication was for

Not rated
Staff "sometimes" or "never" explained new medications8%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that when receiving new medication the staff "Usually" communicated what the medication was for.

Not rated
Staff "usually" explained new medications14%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Always" explained things in a way they could understand

Not rated
Nurses "always" explained things so they could understand79%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Sometimes" or "Never" explained things in a way they could understand

Not rated
Nurses "sometimes" or "never" explained things so they could understand4%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Usually" explained things in a way they could understand

Not rated
Nurses "usually" explained things so they could understand17%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Always" listened carefully to them

Not rated
Nurses "always" listened carefully78%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Sometimes" or "Never" listened carefully to them

Not rated
Nurses "sometimes" or "never" listened carefully3%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Usually" listened carefully to them

Not rated
Nurses "usually" listened carefully19%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Always" treated them with courtesy and respect

Not rated
Nurses "always" treated them with courtesy and respect89%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Sometimes" or "Never" treated them with courtesy and respect

Not rated
Nurses "sometimes" or "never" treated them with courtesy and respect2%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that their nurses "Usually" treated them with courtesy and respect

Not rated
Nurses "usually" treated them with courtesy and respect9%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that the area around their room was "Always" quiet at night

Not rated
"Always" quiet at night65%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that the area around their room was "Sometimes" or "Never" quiet at night

Not rated
"Sometimes" or "never" quiet at night6%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that the area around their room was "Usually" quiet at night

Not rated
"Usually" quiet at night29%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Quietness - linear mean score

Not rated

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Quietness - star rating

4 / 5 — Rating 4 of 5

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported NO, they would probably not or definitely not recommend the hospital

Not rated
"NO", patients would not recommend the hospital (they probably would not or definitely would not recommend it)4%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported YES, they would definitely recommend the hospital

Not rated
"YES", patients would definitely recommend the hospital74%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Recommend hospital - linear mean score

Not rated

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported YES, they would probably recommend the hospital

Not rated
"YES", patients would probably recommend the hospital22%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Recommend hospital - star rating

4 / 5 — Rating 4 of 5

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that when receiving new medication the staff "Always" discussed possible side effects

Not rated
Staff "always" explained possible side effects56%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that when receiving new medication the staff "Sometimes" or "Never" discussed possible side effects

Not rated
Staff "sometimes" or "never" explained possible side effects22%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that when receiving new medication the staff "Usually" discussed possible side effects

Not rated
Staff "usually" explained possible side effects22%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Summary star rating

4 / 5 — Rating 4 of 5

No answer breakdown reported.

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that NO, they did not receive written information about possible symptoms to look out for after discharge

Not rated
No, staff "did not" give patients information about possible symptoms10%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Patients who reported that YES, they did receive written information about possible symptoms to look out for after discharge

Not rated
Yes, staff "did" give patients information about possible symptoms90%

266 completed surveys · response rate 44% · 2024-10-01 → 2025-09-30

Missing measures are not poor results

CMS suppresses a measure when too few cases were reported for the result to be reliable — common for smaller hospitals. A blank means not reported, which is different from a poor result. Hospitals with more blanks are not necessarily worse.

This is not medical advice

These are historical, aggregate measures about an institution. They do not describe the care any individual will receive, and they cannot account for your condition.

Talk to a clinician about your own care. In an emergency, call your local emergency number.

Other Acute Care - Veterans Administration in IN

Source: Centers for Medicare & Medicaid Services (CMS), Provider Data Catalog (data updated 2026-07-22) — https://data.cms.gov/provider-data/ · Data last updated 2026-09-27