Print Almost half of critical access hospitals' star ratings went down this year, and about two-thirds of all U.S. CAH's didn't even get a star, raising questions about whether CMS' new methodology is a more accurate picture of quality, and if the system is even working for these small hospitals. Take Fulton County Health Center in Ohio, which went from four stars last year to one star this year, and is part of a larger trend. Forty-seven percent of CAHs went down at least one star this year, compared to 22% of acute care hospitals. At FCHC their rate of hip and knee replacement complications was below average in the safety and care grouping. All of the other measures reported were better or at average. FCHC CEO Patti Finn said her quality team is reviewing their data on hip and knee replacements, but they have not found out what exactly caused the problem.