Minnesota’s two Veterans Affairs hospitals received high ratings in an internal VA survey on the quality of care provided by the VA at its 146 hospitals across the country.

The VA has used a star system for years to rate the care at its hospitals for each quarter but has refused to release the information, saying it was for internal use only. USA Today reporter Donovan Slack, who has aggressively detailed problems at VA hospitals nationwide, obtained the ratings and published them last month.

The internal documents showed the lowest-performing medical centers were clustered in Texas and Tennessee. VA hospitals in Dallas; El Paso, Texas; Nashville; Memphis and Murfreesboro, Tenn., all received one star out of five as of June 30, the most recent ratings period available.

The newspaper reported that many of the highest-rated facilities were in the Northeast — in Massachusetts and New York — and the Upper Midwest, including in South Dakota and Minnesota. Those medical centers scored five out of five stars.

Both the Minneapolis and St. Cloud VAs scored five stars and were measured on such things as wait times, deaths, infection rates and instances of avoidable complications.

Last month, according to another internal memo obtained by USA Today, the VA posted updated ratings on its website and also included indicators of whether hospitals were improving or declining in performance over the previous quarter or quarters.

The newly posted ratings show VA hospitals in Albuquerque, N.M., Detroit and Los Angeles received one star as of June 30, down from two stars on Dec. 31, 2015. At the same time, the VA Medical Center in Fayetteville, Ark., jumped from three stars to five, and the VA in Orlando went from two stars to four, the newspaper reported.

In addition to star comparisons with other VA medical centers, the newly posted data show whether centers have improved compared with their performance a year earlier. Five hospitals had a “large decline” in the year ending June 30, 2016. Those facilities included the VA hospital in Fargo, where many veterans in northwestern Minnesota receive care. The Fargo facility dropped from a five-star rating in the quarter ending Dec. 31, 2015 to a four-star rating for the quarter ending June 30, 2016.

The USA Today ratings story was criticized by VA leadership, which claimed releasing the information might discourage veterans from going to their VA if the rating for that facility was lower.

VA Secretary Robert McDonald penned an Op-Ed piece critical of the paper’s coverage and raised concerns that the emphasis on the ratings might cause unwarranted distress among veterans.

“We have our fair share of challenges, yet VA remains one of the top medical providers in the country,” McDonald wrote. “Over 80 percent of veterans are satisfied with their care and the VA leads the way in many areas of medicine. Our employees, many of whom are veterans themselves, work incredibly hard to provide veterans the care and services they deserve.”

The high marks for the two Minnesota VAs don’t necessarily mean everything is rosy there.

In August last year, an investigation into the St. Cloud VA found that workloads were so heavy that primary care providers often felt overwhelmed by their responsibilities, adding considerable stress to the work environment.

The same review found no evidence that managers retaliated against whistleblowers who complained of a toxic work environment. It also said top managers have made strides in increasing staffing levels and communication.