Understanding Rating Systems for Home Health Agencies

The Centers for Medicare and Medicaid Services (CMS) offer the encompassing Home Health Compare (HHC) website. However, the amount of information on this site can inundate a consumer who is using it as part of the selection process for a home health provider. With the Affordable Care Act calling for transparent, easily-understood, public reporting of quality of care information, last summer CMS implemented the Quality of Patient Care Star Rating, which is based on OASIS assessment and Medicare claims data. However, by the end of January 2016 this 5-star rating system will not be the only tool available publicly to consumers. Patient Survey Star Ratings based on a patient’s care measures from the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey tool will be visible also on CMS’ Home Health Compare website. These two surveys definitely will help guide consumers as they select a home health provider.

So how are the star ratings determined and is every home health agency automatically included in these evaluation systems? Currently, there are 27 quality measures publicly reported on HHC including 13 process measures, 9 outcome measures, and 5 patient experience of care measures. However, the Quality of Patient Care Star Ratings are based and calculated on a subset of only 9 of these 27 quality measures. These measures include:

Process Measures

  • Timely Initiation of Care
  • Drug Education on all Medications Provided to Patient/Caregiver
  • Influenza Immunization Received for Current Flu Season

Outcome Measures

  • Improvement in Ambulation
  • Improvement in Bed Transferring
  • Improvement in Bathing
  • Improvement in Pain Interfering With Activity
  • Improvement in Dyspnea

In comparison, the new Patient Survey Star Ratings will be based on the HHCAHPS data available for viewing on the HHC website. This information is based on a national, standardized, 34-item HHCAHPS survey of patients’ experience of care provided by their home health agency. The star ratings are applied to each publicly reported composite measure and to the HHCAHPS global item. As you can see below, these measures are based on specific survey questions.

The three HHCAHPS composite measures are determined by the following question categories:

  • Care of Patients comprised of questions 9, 6, 19 and 24.
  • Communication Between Providers and Patients comprised of questions 2, 15, 17, 18, 22, and 23.
  • Specific Care Issues comprised of questions 3, 4, 5, 10, 12, 13, and 14.

The HHCAHPS global item is based on question 20, which relates to the Overall Rating of Care Provided by the Home Health Agency. Finally, the Patient Survey Star Ratings also include a summary star that averages the three composite measures with the overall rating.
However, a home health agency is not automatically included in these two rating systems. After six months of Medicare-certification home health agencies potentially are eligible to participate in the Quality of Patient Care Star Ratings.

However, before a provider can participate it also must have for each measure a minimum of 20 complete quality episodes of data. A quality episode spans from admission or resumption of care to discharge or transfer to an inpatient facility. Since most quality measures are calculated at the time of discharge, episodes must have an end-of-care date within the 12-month reporting period regardless of the start of care date. In addition, agencies also must have reported data for five of the nine measures used in the Quality of Patient Care Star Ratings calculation.

While eligibility for home health agencies to participate in the Patient Survey Star Ratings includes 40 or more completed surveys of data over a four-quarter period. This minimum number of surveys is critical in order to ensure statistical reliability. However, smaller agencies that may not have 40 or more completed surveys for calculating star ratings will still have their HHCAHPS data publicly posted on the HHC website.

As you can see, achieving a 5-star rating is not an easy feat. However, we offer many webinars, onsite training, consulting and manuals that cover the key elements of these rating systems. 5 Star Consultants can help your home health agency to become one of the less than 300 providers across the nation that has achieved a 5-star rating currently. Please contact us today for further information.

Source: Centers for Medicare and Medicaid Services Website

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