For years, individuals looking for home health care have been able to turn to CMS’s Home Health Compare website to find information about the options available in their area. While the site offers a wealth of information, for families in need of medicare health plans and home health services, the sheer volume of information available often felt overwhelming and difficult to navigate.
To help families make informed choices about medicare insurance without slogging through reams of data, CMS introduced last summer a star rating system to indicate the overall quality of home health agencies. Similar to the system used to evaluate insurance companies, the home health star rating system rates agencies based on their performance on specific criteria. Individuals can see at a glance how a particular agency ranks not only in terms of their quality, but also how they rate against other agencies in the area.
The response to the new star rating system has been mixed. Proponents applaud CMS’ efforts to simplify the process of choosing a home health agency, while critics claim that the stars only tell part of the story. To wit, only 2.6 percent of the 9,000 agencies that were rated under the star system received five stars, with the majority of HHAs falling in the average range of three stars. Officials note that three stars indicates a high quality of care, but home health providers worry that individuals looking for care won’t understand the context of the ratings, and overlook agencies with a lower star rating.
Star Ratings Broken Down
So what makes an agency a five-star agency? According to CMS, star ratings are calculated by gauging performance on nine of the 27 current process and outcome quality measures. These measures include initiating care in a timely manner, providing flu shots to all patients, and providing medication education, as well as improvement in pain, bed transferring, bathing, ability to walk, and shortness of breath. Reduced acute hospitalizations are also measured in the rating system.
In order to participate in the system, Medicare-certified home health agencies must also have enough data to make the ratings statistically significant. This translates tohaving data for at least five of the nine data measures, and at least 20 complete quality episodes for each measure. These episodes must have been within the previous 12-month period for each rating quarter. These requirements actually disqualified nearly a quarter of all home health agencies from the star rating program altogether, because they did not have enough data to provide an accurate rating.
The fact that only 75 percent of agencies are even included in the program is just one issue that experts have with the rating system. Home health care representatives have expressed concern that not only does CMS only allot for a certain number of agencies in each category — essentially guaranteeing that a majority will receive average or mediocre ratings — but that the criteria for ratings isn’t always reflective of the patient population that they serve.
The average home health patient is 85 years old, and living with multiple chronic conditions that aren’t necessarily going to improve; for them, home health is primarily devoted to maintaining their quality of life and preventing deterioration.
Still, CMS holds that the quality measures are useful for individuals looking for home health services, making it easy for them to compare multiple agencies at a glance. And while currently the star ratings have no bearing on reimbursements to providers, they do have the potential to reduce an agency’s client base, thus making performance in these areas a priority for many agencies. Long-term care facilities may then seek Medicare reimbursement consulting services to make the reimbursement processes much easier and manageable.
Earning Five Stars
Earning a five-star rating from CMS is a lofty goal, but many home health agencies are taking on the challenge and making changes to their operations to better comply with the measures set by CMS. However, as experts point out, a significant challenge for many agencies is the fact that the data used to determine rankings is self-reported.
Among the agencies that received five stars, many reporting collecting real-time patient data via advanced home health care software, which allows them to update patient information on a regular basis and ensure that CMS receives the most accurate and up-to-date information.
Five-star agencies also report reconfirming their commitment to customer service as a key aspect of their successful rating. Focusing on what is right for the patient, with an eye toward as much improvement as possible, has proven a winning strategy for many HHAs.
HHA star ratings have the potential to revolutionize home health, and improve care delivery overall. Agencies that consistently focus on delivering excellent care will continue to receive high marks, while other will be forced to improve — or face serious consequences.
