Choosing the right home health care provider is a critical decision for individuals and their families. To assist in this process, the Centers for Medicare & Medicaid Services (CMS) has developed Care Compare, a user-friendly website integrated within Medicare.gov. This platform serves as an official and accessible source of information designed to evaluate and compare the quality of home health agencies. Alongside the launch of the new Provider Data Catalog, CMS has enhanced Medicare’s Compare sites, making it simpler than ever to find and utilize publicly reported data.
Central to Care Compare’s functionality are home health star ratings. These ratings are designed to simplify complex performance data, offering consumers an at-a-glance summary of a provider’s quality of care. While star ratings are a valuable tool, it’s important to remember they are one component of the comprehensive quality information available on Care Compare, intended to empower informed healthcare choices.
Decoding the Calculation of Home Health Star Ratings
CMS prioritizes transparency and stakeholder engagement in the development and refinement of Care Compare’s star ratings. Recognizing the significance of this information for home health agencies, stakeholders, and consumers alike, CMS employs a meticulous and open process. This ensures all involved parties have the opportunity to:
- Understand the Development Process: Gain clear insights into how the star rating methodologies are established and updated.
- Provide Input and Feedback: Contribute to the ongoing evolution of Care Compare to ensure it effectively serves its users and those affected by its ratings.
CMS utilizes diverse channels to disseminate information and solicit feedback. The current methodologies for calculating and reporting star ratings are a direct result of stakeholder input and continuous data analysis. Acknowledging the dynamic nature of healthcare quality measurement, CMS anticipates that these star ratings will continue to evolve, incorporating refinements over time to better reflect provider performance and patient outcomes. The agency actively encourages ongoing review and feedback to ensure the star ratings remain relevant, accurate, and beneficial.
Exploring the Two Types of Home Health Star Ratings
Care Compare features two distinct types of star ratings, each providing a unique perspective on home health agency performance:
- Quality of Patient Care Star Ratings: These ratings evaluate the actual care provided by home health agencies based on clinical data.
- Patient Survey Star Ratings: These ratings reflect the experiences of patients receiving care from home health agencies, capturing their perspectives on the quality of services.
In-Depth Look at Quality of Patient Care Star Ratings
The Quality of Patient Care (QoPC) Star Rating is derived from data submitted through OASIS (Outcome and Assessment Information Set) assessments and Medicare claims data. First introduced in July 2015, these ratings are updated quarterly, ensuring they reflect the most current performance data available on Care Compare.
To be eligible for a Quality of Patient Care Star Rating, Medicare-certified Home Health Agencies (HHAs) must meet specific data reporting criteria. Agencies are required to have data for at least 20 completed quality episodes for each measure to be assessed. These episodes are defined by the start or resumption of care and end-of-care OASIS assessments, with the end-of-care date falling within the 12-month reporting period. Furthermore, to receive a QoPC star rating, HHAs must report data for a minimum of 5 out of the 7 measures included in the rating calculation. Detailed information on the current methodology for calculating the Quality of Patient Care Star Rating is typically accessible in the “Downloads” section of the relevant CMS webpage, and is subject to periodic updates as methodologies are refined.
Approximately 3.5 months before public release on Care Compare, each HHA receives Provider Preview reports. These reports detail their Quality of Patient Care Star Ratings and the underlying calculations. This preview period allows agencies several weeks to review the data and submit evidence of any calculation errors for CMS review. To support agencies in understanding these reports, CMS previously hosted webinars, such as one on March 26, 2015. Materials from these webinars, including sample reports and instructions for requesting rating reviews, are often available in the “Downloads” section.
A sample preview report illustrating the format of the Quality of Patient Care Star Rating Provider Preview Report, designed to help home health agencies understand their ratings before public release on Care Compare.
Measures Included in Quality of Patient Care Star Ratings
The methodology for Quality of Patient Care Star Ratings incorporates a set of process and outcome quality measures already publicly reported on Care Compare. These measures are carefully selected based on several key criteria:
- Broad Applicability: Measures should be relevant to a significant portion of the home health patient population and have sufficient data available for the majority of home health agencies.
- Meaningful Variation: Measures should demonstrate reasonable performance differences among agencies, allowing for the potential for improvement.
- Clinical Relevance and Validity: Measures must be clinically meaningful and accurately reflect important aspects of patient care.
- Stability and Reliability: Measures should be consistent over time and not subject to substantial random fluctuations.
- Responsiveness to Improvement: Measures should be sensitive to changes in agency performance, reflecting improvements over time based on ongoing monitoring, expert input, and stakeholder feedback.
The seven measures currently utilized in the Quality of Patient Care Star Rating are:
- Timely Initiation of Care (process measure): Ensures that necessary home health services begin promptly after referral.
- Improvement in Ambulation (outcome measure): Measures the agency’s effectiveness in helping patients improve their ability to walk or move around.
- Improvement in Bed Transferring (outcome measure): Assesses improvement in patients’ ability to move in and out of bed.
- Improvement in Bathing (outcome measure): Evaluates progress in patients’ ability to bathe themselves.
- Improvement in Shortness of Breath (outcome measure): Measures the agency’s success in managing and reducing patients’ shortness of breath.
- Improvement in Management of Oral Medications (outcome measure): Assesses improvement in patients’ ability to manage their oral medications safely and effectively.
- Potentially Preventable Hospitalization (outcome measure): Reflects the rate of hospitalizations that could potentially have been avoided with better home health care management.
Deep Dive into Patient Survey Star Ratings
Patient Survey Star Ratings are based on the patient experience of care, gathered through the Home Health CAHPS (Consumer Assessment of Healthcare Providers and Systems) Survey. These ratings were initially published in January 2016 and are also updated quarterly. Comprehensive information regarding Patient Survey Star Ratings is available on the dedicated HHCAHPS website.
Similar to QoPC ratings, all Medicare-certified HHAs are eligible for Patient Survey star ratings. However, agencies must have at least 40 completed surveys over a four-quarter reporting period to receive a rating. Agencies with fewer than 40 completed surveys will still have their HHCAHPS data publicly reported on Care Compare but will not receive star ratings due to concerns about statistical reliability with smaller sample sizes. More detailed information on the calculation methods for Patient Survey star ratings can be found on the HHCAHPS survey website.
HHAs also receive Provider Preview reports for Patient Survey star ratings, approximately one month before public posting on Care Compare. This allows agencies to review their ratings and submit any evidence of calculation errors for review.
Information about the Home Health CAHPS survey, the basis for Patient Survey Star Ratings, designed to capture patient experiences and perspectives on home health care quality.
Measures Included in Patient Survey Star Ratings
The Patient Survey star ratings incorporate four key measures reported on Care Compare, derived from specific questions within the HHCAHPS survey:
- Care of Patients: Reflects patient perceptions of the overall care received, based on survey items Q9, Q16, Q19, and Q24.
- Communication Between Providers and Patients: Evaluates the effectiveness of communication, encompassing survey items Q2, Q15, Q17, Q18, Q22, and Q23.
- Specific Care Issues: Addresses patient experiences with specific aspects of care, including survey items Q3, Q4, Q5, Q10, Q12, Q13, and Q14.
- Overall Rating of Care Provided by the Home Health Agency: Represents the patient’s comprehensive assessment of the agency’s care, based on survey item Q20.
Notably, the “Willingness to Recommend the HHA” item is not included in the star rating calculation because its results closely mirrored the “Overall Rating of Care.”
Accessing More Information and Providing Feedback
For further inquiries or to provide feedback regarding home health star ratings, please utilize the following contact points:
- Patient Survey Stars & Home Health CAHPS: Contact via phone at 1-866-354-0985, or visit the HHCAHPS website.
- Quality of Patient Care Star Ratings: Email inquiries to [email protected].
- Formal Review Requests for Quality of Patient Care Star Ratings (including data suppression requests): Submit requests to [email protected].
Important Privacy Note: Please do not include any identifiable patient information in email communications, including medical record numbers, dates of birth, service dates, or any data considered Protected Health Information (PHI) under HIPAA.
For additional resources, including sample preview reports, methodology documents for both OASIS and Medicare claims-based measures, and Frequently Asked Questions, please refer to the “Downloads” section on the relevant CMS webpage. Your questions and comments are valuable and encouraged; please direct them to [email protected].
By utilizing Care Compare and understanding home health star ratings, consumers are better equipped to make informed decisions about their home health care needs, ensuring access to quality services that meet their individual circumstances.
