Home Health Star Ratings

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What are the home health star ratings?

The Centers for Medicare & Medicaid Services (CMS) has built the Care Compare website at 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.

To make the information easier to use, Care Compare provides tools like “star ratings" that summarize some of the current health care provider performance measures. The star ratings offer consumers another tool to help them make health care decisions. Consumers will still find value in the other quality information on Care Compare.

How are the home health star ratings calculated?

Because CMS knows the information posted on Care Compare is very important to home health agencies, other stakeholders, and consumers, 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 Care Compare reflects those who use it or are affected by it.

CMS has shared information in many ways. The way CMS calculates and reports the star ratings now is based on input from stakeholders and ongoing data analysis. CMS expects the star ratings will evolve and be refined over time. CMS hopes that you'll review the 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. CMS first posted these ratings in July 2015, and CMS continues to update them quarterly based on new data posted on Care Compare.

Patient Survey Star Ratings are based on the Home Health CAHPS Survey. CMS first posted these ratings in January 2016 and CMS continues to update them quarterly based on new data posted on Care Compare.

Details about Quality of Patient Care star ratings

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 Care Compare. Completed episodes are paired with the 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 the start date. To have a Quality of Patient Care Star Rating computed, HHAs must have reported data for 5 of the 7 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 Downloads 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 Care Compare. 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, CMS sponsored a webinar (PDF) to review the format of the report and the process for requesting a 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 this webpage. 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 (PDF).

Which measures are included?

The Quality of Patient Care Star Rating methodology includes process and outcome quality measures that are currently reported on Care 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 performance improvement.
• 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 7 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 Shortness of Breath (outcome measure),
• Improvement in Management of Oral Medications (outcome measure),
• Potentially preventable hospitalization (outcome measure).

Details about Patient Survey star ratings

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

All Medicare-certified HHAs have the potential to receive a Patient Survey star rating. However, HHAs must have 40 or more completed surveys over the four-quarter reporting period to receive Star Ratings for that reporting period. Home health agencies that do not have 40 or more completed surveys for calculating Star Ratings will still have their HHCAHPS data publicly reported on the Home Health Compare website, but they will not receive star ratings.

HHCAHPS scores based on fewer than 40 completed surveys do not have sufficient statistical reliability to ensure that those scores measure true performance and not noise in the data for reporting star ratings. More details about the methods for calculating Patient Survey star ratings can be found on the HHCAHPS survey website.

Each HHA gets Provider Preview reports showing the Patient Survey star ratings about one month before the ratings are posted on Care Compare. Agencies have several weeks to review and send us proof that there's been a calculation error to ask us to review their rating.

Which measures are included?

The Patient Survey star ratings include four of the measures reported on Care Compare. They are:

• Care of Patients (Survey items: Q9, Q16, Q19, and Q24),
• Communication Between Providers and Patients (Survey items: Q2, Q15, Q17, Q18, Q22, and Q23),
• Specific Care Issues (Survey items: Q3, Q4, Q5, Q10, Q12, Q13, and Q14),
• Overall Rating of Care Provided by the Home Health Agency (Q20).

The star rating does not include the Willingness to Recommend the HHA item because the results for this item were very similar to those based on the Overall Rating of Care.

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

Here's whom you can contact if you have questions or want to give feedback:

• Patient Survey Stars & Home Health CAHPS:  or call 1-866-354-0985.
• Quality of Patient Care Star Ratings: homehealthqualityquestions@cms.hhs.gov
• All requests for formal review of Quality of Patient Care Star Ratings including requests to suppress data: HHC_Star_Ratings_Review_Request@cms.hhs.gov.
• 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 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 document, which is updated periodically as new comments and questions are received. You are encouraged to submit any questions or comments you have about the Star Ratings to homehealthqualityquestions@cms.hhs.gov

Downloads