Home Health Quality Reporting Program
Home Health Services
Home health is a covered service under the Part A Medicare benefit. It consists of part-time, medically necessary, skilled care (nursing, physical therapy, occupational therapy, and speech-language therapy) that is ordered by a physician.
In 2018, there were 11,869 Medicare certified home health agencies throughout the United States. In 2018, 5,125,575 beneficiaries were served through 7,228,721 episodes of care. These counts include Medicare Fee for Service (FFS), Medicare Advantage and Medicaid beneficiaries for whom OASIS collection is required. In 2018, approximately eight percent of episodes were paid (at least partially) by Medicaid, 30 percent by Medicare Advantage, and the remaining 62 percent by Medicare FFS.
Home Health Quality Goals
Quality health care for people with Medicare is a high priority for the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services (CMS).
CMS has adopted the mission of the National Academy of Medicine (formerly the Institute of Medicine) which has defined quality as having the following properties or domains:
- Effectiveness Relates to providing care processes and achieving outcomes as supported by scientific evidence.
- Efficiency Relates to maximizing the quality of a comparable unit of health care delivered or unit of health benefit achieved for a given unit of health care resources used.
- Equity Relates to providing health care of equal quality to those who may differ in personal characteristics other than their clinical condition or preferences for care.
- Patient Centeredness Relates to meeting patients' needs and preferences and providing education and support.
- Safety Relates to actual or potential bodily harm.
- Timeliness Relates to obtaining needed care while minimizing delays.
Reporting Home Health Quality using OASIS Data
The instrument/data collection tool used to collect and report performance data by home health agencies is called the Outcome and Assessment Information Set (OASIS). Since 1999, CMS has required Medicare-certified home health agencies to collect and transmit OASIS data for all adult patients whose care is reimbursed by Medicare and Medicaid with the exception of patients receiving pre- or postnatal services only. OASIS data are used for multiple purposes including calculating several types of quality reports which are provided to home health agencies to help guide quality and performance improvement efforts.
OASIS-D is the current version of the OASIS data set. It was implemented on January 1, 2019. OASIS-D includes multiple new standardized items to support measurement domains mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. New items were also added for standardization to align with assessment sets for other post-acute care settings. Several items were also removed to reduce provider and patient burden. OASIS-D was approved by the Office of Management and Budget (OMB) on December 6, 2018, with an expiration date of 12/31/2021. The valid OMB control number for this information collection is 0938- 1279.
Quality Reporting on the Home Health Compare Website
Since fall 2003, CMS has posted a subset of OASIS-based quality performance information on the Medicare.gov website “Home Health Compare” (see link below). These publicly-reported measures include outcome measures which indicate how well home health agencies assist their patients in regaining or maintaining their ability to function and process measures which evaluate the rate of home health agency use of specific evidence-based processes of care.
Lists of all home health quality measures and designation of which are publicly reported can be found on the Quality Measures page accessed from the list on the left of this page.
In 2015, CMS added star ratings to the Home Health Compare website to summarize some of the current measures of home health care provider performance that have been publicly reported. The star ratings are an additional tool to support consumers’ health care decision-making.