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Home Health Star Ratings

CMS established the Home Health Compare (HHC) website on Medicare.gov as a key tool for consumers to use when choosing a home health care provider.  It is designed to be an easy-to-access, convenient source of authoritative information on provider quality.  However, even the information on HHC can seem like “too much of a good thing” to consumers faced with an urgent need to make a choice – too much information, too many measures to consider.

Therefore, CMS has begun adding new tools to HHC in order to make the information there easier to use – “star ratings” that will summarize some of the current measures of health care provider performance that the site already offers.  The star ratings are an additional tool to support consumers’ health care decision-making; none of the current information on the site is being removed.

Recognizing that the information posted on HHC is very important to home health agencies and other stakeholders in addition to consumers, CMS has been committed to assuring that all stakeholders have an opportunity to learn about the development of the star ratings and to give their input so that the system can reflect the perspectives of those who use it or are affected by it, based on a transparent development process.  To this end, we have been sharing information in a number of ways, as detailed below.  The current methodology for calculating and reporting the star ratings incorporates a number of changes based on input received from stakeholders as well as ongoing data analysis, and we anticipate that the star ratings will continue to evolve and be refined over time.  We hope that you will review information as it becomes available, and will take the opportunity to provide us with your input.

Please send all questions and comments to the appropriate addresses below:

Questions related to the Home Health CAHPS Survey or the Patient Survey Star Ratings:

Patient Survey Stars & Home Health CAHPS: hhcahps@rti.org; Phone: 1-866-354-0985

Questions related to HH Quality of Patient Care Star Ratings, including related preview reports and methodology for calculation using OASIS-based and Medicare claims-based measures:

Quality of Patient Care Star Ratings: homehealthqualityquestions@cms.hhs.gov

All requests for formal review of Quality of Patient Care Star Ratings including requests to suppress data: HHC_Star_Ratings_Review_Request@cms.hhs.gov.

PLEASE DO NOT SEND ANY IDENTIFIABLE PATIENT INFORMATION THROUGH EMAIL. This includes medical record numbers, dates of birth, service dates (including visit dates, admission dates, or discharge dates), or any other data items considered identifiers or Protected Health Information (PHI) under HIPAA. 

Our goal is to provide consumers with tools that will help them make the best decisions about their health care. 

Two types of star ratings

The Quality of Patient Care Star Rating is based on OASIS assessments and Medicare claims data.  These ratings were first published on HHC in July, 2015. The methodology for calculation of this rating is described below.

Patient Survey Star Ratings are based on the patient experience of care measures. These ratings were first published on HHC in January, 2016. All information about the Patient Survey Star Ratings is posted on the HHCAHPS website. Questions or comments about the HHCAHPS Patient Survey Star Ratings can be submitted to: HHCAHPS@RTI.org.

Quality of Patient Care Star Rating Methodology

Which measures are included? - The initial Quality of Patient Care Star Rating methodology included 9 of the 18 currently reported process and outcome quality measures. These measures were chosen based on the following criteria:

  • The measure should apply to a substantial proportion of home health patients and have sufficient data to report for a majority of home health agencies.
  • The measure should show a reasonable amount of variation among home health agencies and it should be possible for a home health agency to show improvement in performance.
  • The measure should have high face validity and clinical relevance.
  • The measure should be stable and not show substantial random variation over time.

The 9 measures selected based on these criteria are:

Process Measures:

1. Timely Initiation of Care
2. Drug Education on all Medications Provided to Patient/Caregiver
3. Influenza Immunization Received for Current Flu Season*

Outcome measures:

4. Improvement in Ambulation
5. Improvement in Bed Transferring
6. Improvement in Bathing
7. Improvement in Pain Interfering With Activity
8. Improvement in Shortness of Breath
9. Acute Care Hospitalization

*This measure was removed beginning with the April 2018 Home Health Compare refresh.

(Background information on the quality measures themselves is available via the “Home Health Quality Measures” link in the Useful Links section below.)

Which HHAs receive Quality of Patient Care Star Ratings? -- All Medicare-certified HHAs are potentially eligible to receive a Quality of Patient Care Star Rating. Currently, HHAs must have at least 20 complete quality episodes for data for each measure to be reported on HHC. (Completed episodes are paired start or resumption of care and end of care OASIS assessments.) Episodes must have an end-of-care date within the 12-month reporting period regardless of start date. To have a Quality of Patient Care Star Rating computed, HHAs must have reported data for 5 of the 9 measures used in the Quality of Patient Care Star Ratings calculation.  The current methodology for calculating the Quality of Patient Care Star Rating can be accessed via the Related Links section below. This methodology will be updated periodically as additional refinements are made.

When are Quality of Patient Care Star Ratings Updated? – The Quality of Patient Care Star Ratings were first published on HHC in July, 2015, and will be updated quarterly thereafter based on the new data that are published on Home Health Compare.

Quality of Patient Care Star Rating Provider Preview Reports - Provider preview reports showing the Quality of Patient Care Star Ratings and rating calculations for each agency are distributed to each agency approximately 3.5 months before the ratings are published on Home Health Compare.  Agencies have several weeks to review and, if they can submit evidence that the data used to calculate the measures were inaccurate or incomplete to the extent that their star rating was affected, they can request CMS review of their rating.  CMS sponsored a webinar to review the format of the report and the process for requesting review of the Quality of Patient Care Star Rating on March 26, 2015. A link to the recording of the webinar is included in the Useful Links section below. A sample report illustrating the format of the Quality of Patient Care Star Rating Provider Preview Report and the slides from the webinar are posted in the Downloads section below.

Updates

January 2, 2018

Home Health QRP: Transcript and Audio from Removal of Influenza Vaccination Measure from Quality of Patient Care Star Rating Webinar Available

An audio recording and transcript is now posted on the Home Health QRP Training webpage for the December 14, 2017 webinar on Removal of Influenza Vaccination Measure from Quality of Patient Care Star Rating.

December 13, 2017

A summary of public comments received in response to the proposed removal of the Influenza Immunization measure from the Quality of Patient Care star rating calculation is available in the downloads section. The public comment period was from October 11 to November 11, 2017. The comments received show support for this proposal and will be discussed during the December 14 HH QRP webinar on changes to the calculation algorithm and timeline.   

November 03, 2016

QoPC TEP Update

 A follow-up meeting of the Quality of Patient Care (QoPC) Technical Expert Panel (TEP) was held on September 20, 2016. The purpose of the webinar was to review the results of additional analysis recommended by the TEP, along with revised communication materials.  The TEP summary, an updated sample preview report and a fact sheet for stakeholders have been added to the Downloads section below.

Additional Information

Special Open Door Forums –

  • The first Quality of Patient Care Star Ratings Special Open Door Forum (SODF) was held on December 17, 2014 to present the proposed methodology for calculating the HHC Star Ratings and to get stakeholder input. The slide deck for this SODF is posted in the Downloads section below, A link to the transcript and audio recording of this SODF is included in the Related Links section below.
  • A second Quality of Patient Care Star Ratings Special Open Door Forum (SODF) was held on February 5, 2015 to present a summary of stakeholder comments received and proposed revisions to the methodology, and to invite additional stakeholder input. The slide deck for this SODF is also posted in the Downloads section below, and a link to the transcript and audio recording of this SODF is also included in the Related Links section below.

Frequently Asked Questions (FAQs) – An updated FAQ document is included in the Downloads section below. This document is updated periodically as new comments and questions are received. You are encouraged to submit any questions or comments you may have about the star ratings to HomeHealthQualityQuestions@cms.hhs.gov.

Useful Links

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