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CMS Star Rating Scale Presents Opportunities to Refine Quality Reporting


Based on the new federal data released in July, most of the 12,000+ U.S. home health agencies ranked in the middle of the CMS five-star rating scale designed to help the public compare quality and safety among providers. While the industry reaction and response have brought a wide range of reviews, these rankings on Home Health Compare present many opportunities to improve performance for the process and outcomes measures that will now remain in the public eye moving forward.

To date, CMS has developed star-rating efforts for many aspects of the health care experience, from hospitals and nursing homes to pharmacy services, dialysis care and Medicare Advantage plans. “Home care scrutiny and public reporting is a natural progression in the series of CMS efforts to assist consumers in differentiating among providers,” says Robert J. Simione, Managing Principal, Simione Healthcare Consultants. “By establishing more diligent plans for quality reporting, home care agencies will be better prepared to thrive as the emphasis on post-acute services increases to improve quality and reduce the cost of care.  We are working to help providers embrace quarterly 5-star ratings as an opportunity to stay competitive. Data-driven results will benefit all agencies as our industry faces greater visibility by consumers, CMS, ACOs, payers or other organizations,” he said.

The Quality of Care Star Rating

First published in July 2015, the Quality of Care Star Rating is based on OASIS assessments and Medicare claims data.  The methodology includes 9 of the 27 currently reported process and outcome quality measures chosen by CMS because they: 

  • 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 allow providers to show improvement in performance
  • have high face validity and clinical relevance
  • are stable and do 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

All Medicare-certified home health agencies are eligible to receive the Quality of Patient Care Star Rating.  Each agency must have at least 20 complete quality episodes for data for each measure to be reported on Home Health Compare.  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 the Quality of Patient Care Star Rating computed, home health agencies must have reported data for 5 of the 9 measures used in the calculation.

CMS expects that its star ratings will continue to evolve and be refined over time; the agency is encouraging providers to review information as it becomes available and to provide input. Questions and comments should be sent to[email protected].  

In January 2016, CMS plans to publish Patient Survey Star Ratings, which will rank agencies based on the HHCAHPS survey data.  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[email protected]

Simione Healthcare Consultants can help you evaluate and improve quality reporting to enhance your agency’s overall ratings by CMS. For more information, call us at 844.215.8822.