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Home Health Star Ratings

What are the home health star ratings?                                                                 

We built the Home Health Compare (HHC) website on Medicare.gov as a key tool to help consumers choose a home health care provider. It’s designed to be an easy-to-access, convenient official source of information about provider quality. However, sometimes the information on HHC can seem like “too much of a good thing” to consumers who have to make an urgent choice and there’s too much information and too many measures to consider.

To make the information easier to use, we’ve started adding new tools to HHC like “star ratings” that summarize some of the current health care provider performance measures. The star ratings give consumers another tool to help them make health care decisions, but we aren’t removing any of the information that’s always been on HHC. 

How are the home health star ratings made?

Because we know the information posted on HHC is very important to home health agencies, other stakeholders, and consumers, we’re using a transparent development process to make sure all stakeholders:

  • Have the chance to learn about how the star ratings were developed.
  • Give input so HHC reflects those who use it or are affected by it.

We’ve been sharing information many ways. The way we calculate and report the star ratings now is based on input from stakeholders and ongoing data analysis. We expect the star ratings will evolve and be refined over time. We hope that you’ll review new information and will give us input. 

What are the types of home health star ratings?

There are two types of home health star ratings:

  1. Quality of Patient Care Star Ratings
  2. Patient Survey Star Ratings

The Quality of Patient Care (QoPC) Star Rating is based on OASIS assessments and Medicare claims data. We first posted these ratings on HHC in July 2015 and we’ll update them quarterly based on new data posted on HHC.

All Medicare-certified HHAs may potentially receive a Quality of Patient Care Star Rating. HHAs must have data for at least 20 complete quality episodes 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 8 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 Useful Links section below. This methodology will be updated periodically as additional refinements are made.

Each HHA gets provider preview reports showing the Quality of Patient Care Star Ratings and rating calculations about 3.5 months before the ratings are posted on HHC. Agencies have several weeks to review and send us proof that there’s been a calculation error to ask us to review their rating. On March 26, 2015, we sponsored a webinar to review the format of the report and the process for requesting review of the Quality of Patient Care Star Rating. You can download a sample report illustrating the format of the Quality of Patient Care Star Rating Provider Preview Report and instructions for submitting requests for review from the Downloads section of the Home Health Star Ratings page. You can also see a sample report illustrating the format of the Quality of Patient Care Star Rating Provider Preview Report and the slides from the webinar.

Which measures are included?

The initial Quality of Patient Care Star Rating methodology includes 8 process and outcome quality measures that are currently reported on Home Health Compare. These measures should:

  • Apply to a substantial proportion of home health patients and have sufficient data to report for a majority of home health agencies.
  • 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.
  • Have high face validity and clinical relevance.
  • Be stable and not show substantial random variation over time.
  • Have changed over time based on the results of ongoing monitoring analyses, technical expert panel input, and stakeholder feedback.

The 8 measures that are part of the Quality of Patient Star Rating are:

  • Timely Initiation of Care (process measure)
  • Improvement in Ambulation (outcome measure)
  • Improvement in Bed Transferring (outcome measure)
  • Improvement in Bathing (outcome measure)
  • Improvement in Pain Interfering With Activity (outcome measure)
  • Improvement in Shortness of Breath (outcome measure)
  • Improvement in Management of Oral Medications (outcome measure)
  • Acute Care Hospitalization (claims-based) (outcome measure)

 We base the Patient Survey Star Ratings on the patient experience of care measures. We first posted these ratings on HHC in January 2016 and we post all information about the Patient Survey Star Ratings on the HHCAHPS website.

Where can I learn more about the home health star ratings?

Here’s who you can contact if you have questions or want to give feedback:

Please don’t send any identifiable patient information through the mail, including 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.

Please see the Useful Links and Downloads section at the bottom of this page for more information about the Home Health Star Ratings. These resources include sample preview reports and methodology for calculation using OASIS-based and Medicare claims-based measures. They also include a Frequently Asked Questions documents which is updated periodically as new comments and questions are received. You are encourage to submit any questions or comments you  may have about the Star Ratings to homehealthqualityquestions@cms.hhs.gov

Updates

October 30, 2018

Starting with the April 2019 Home Health Compare refresh, the QoPC Star Ratings will have the Drug Education on All Medications Provided to Patient/Caregiver during All Episodes of Care measure removed and the Improvement in Management of Oral Medications measure added. Provider Preview Reports will show these changes in January 2019. The data reporting period for this refresh will be July 1, 2017 to June 30, 2018 for OASIS-based measures and CY 2017 for the claims-based measure. These changes to the calculation algorithm were first presented during an MLN call on June 27, 2018, which was followed by a 30-day public comment period ending July 26, 2018. CMS summarized the public comments and announced final changes during an October 3rd, 2018 MLN call.

For more information, please see the Medicare Learning Network event slides available here.

Useful Links