Numerous publicly available sites now exist that purport to provide objective information for patients about hospital quality and safety, including Leapfrog and the Centers for Medicare and Medicaid Services star rating system. This article evaluated four widely used hospital rating systems and found that all suffered from methodological limitations that led to potential misclassification of hospital performance. The results are similar to a 2007 analysis, indicating that over the past decade online rating systems have proliferated in quantity, but not quality.