Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey Star Ratings are now on Home Health Compare
Home Health Compare is a user-friendly web tool found at https://www.medicare.gov/homehealthcompare/search.html that provides information on how well Medicare-certified home health agencies (HHAs) provide care to their patients. This information can help patients, their families, caregivers, and providers make more informed decisions about choosing an agency. Home Health Compare allows patients to select multiple agencies at a time to compare the clinical quality of care provided and patient experiences at these agencies. The clinical information comes from data from the Outcome and Assessment Information Set (OASIS) and the patient experiences of care data come from HHCAHPS.
On January 28, 2016 the Centers for Medicare & Medicaid Services (CMS) added HHCAHPS star ratings to the Home Health Compare website as part of an initiative to simplify the quality of care information across all CMS Compare websites. Prior to this public reporting, HHAs were given preview reports to review their HHCAHPS data and their HHCAHPS star ratings. These are posted on the HHCAHPS website and the agencies can access their own data by using their user IDs and passwords.
CMS and the Agency for Healthcare Research and Quality (AHRQ) have led a partnership of public and private organizations to publicly report patients’ experience of care measures. Star ratings allow comparisons of health care quality and make it easier for patients to use the detailed information on the Compare websites. This effort to simplify information is consistent with the Affordable Care Act, which calls for transparent, easily understood, and widely available public reporting.
Background
Star ratings help patients, their family members, and caregivers more easily compare health care providers. Starting in 2006, CMS began incorporating star ratings in its Compare websites, including Medicare Plan Finder.
- Nursing Home Compare (https://www.medicare.gov/nursinghomecompare/search.html) features an overall star rating for each nursing home.
- Physician Compare (https://www.medicare.gov/physiciancompare/search.html) uses star ratings to display ratings for several meaningful measures for group practices.
- Medicare Plan Finder (https://www.medicare.gov/find-a-plan/questions/home.aspx) is a vital tool in Medicare Open Enrollment, and uses star ratings to help people select Medicare Part C and Part D plans. Medicare Plan Finder star ratings additionally determine Quality Bonus Payments for Medicare Advantage plans.
- In 2015 CMS introduced star ratings for Dialysis Compare (https://www.medicare.gov/dialysisfacilitycompare/#search), for Hospital CAHPS survey measures on Hospital Compare (https://www.medicare.gov/hospitalcompare/search.html), and for OASIS quality of patient care measures on Home Health Compare (https://www.medicare.gov/homehealthcompare/search.html).
Today’s update to Home Health Compare introduces star ratings for its patient experience of care survey results data from the HHCAHPS Survey.
HHCAHPS Star Ratings on Home Health Compare
The HHCAHPS Survey is a standardized 34-question survey that measures patients’ experiences and perspectives of their home health care. The HHCAHPS Survey results posted on Home Health Compare provide ratings with comparisons to state and national averages that help patients, their families, and caregivers understand how home health care patients rate their experiences with the agencies providing their home health care.
HHCAHPS star ratings provide a quick summary of each measure in a simple, familiar format that enables patients to more quickly and easily understand this information.
CMS encourages patients to consider multiple factors when choosing an agency, of which the new HHCAHPS star ratings summarize one factor of home health quality—patients’ experience of care. In addition, patients should discuss home health quality with their healthcare professionals when selecting an agency.
Five HHCAHPS Star Ratings on Home Health Compare
HHCAHPS star ratings simplify the HHCAHPS Survey results currently displayed on Home Health Compare. The star ratings do not add new underlying data or replace any data that is currently posted on Home Health Compare; rather, they summarize, in an easy-to-understand format, agency performance on HHCAHPS items that were already being reported.
HHCAHPS star ratings range from 1 to 5 with 5 being the highest rating reflecting better patient experiences. There are no half stars for HHCAHPS star ratings, because half stars for HHCAHPS did not provide meaningful statistical differences across star groups.
Consumers will now find five HHCAHPS star ratings on Home Health Compare:
- Care of Patients
- Communication Between Providers and Patients
- Specific Care Issues
- Overall Rating of Care provided by the Home Health Agency
- Survey Summary star rating
HHCAHPS star ratings are used for three composite measures, which combine scores from several sets of questions on the HHCAHPS Survey. These three composites are:
- Care of Patients (Q9, Q16, Q19, Q24)
- Communication Between Providers and Patients (Q2, Q15, Q17, Q18, Q22, Q23)
- Specific Care Issues (Q3, Q4, Q5, Q10, Q12, Q13, Q14)
A fourth star rating is used for the survey question, “Overall Rating of Care Provided by the HHA (Q20).”
A fifth star rating is a summary star, called the Survey Summary star rating, and it is a simple average of the four other star ratings.
CMS reports the HHCAHPS Survey data results for the “Patient’s Willingness to Recommend the HHA to Family and Friends (Q25)” on Home Health Compare, but it is not provided in a star rating because the question provides very similar information to the “Overall Rating of the HHA (Q20).”
Methodology of HHCAHPS Star Ratings
The Patient Survey star ratings are derived from the home health patient surveys. The HHCAHPS Survey is uniformly implemented by independent CMS-approved survey vendors that are not affiliated with HHAs and that do not provide home health services. Thus, the data are not self-reported by HHAs.
HHCAHPS star ratings are assigned in a way that minimizes differences within groups and maximizes differences between groups. The clustering algorithm empirically determines the number of home health agencies in each star rating category independently for each HHCAHPS measure.
Calculating the HHCAHPS star ratings for the four HHCAHPS measures (the three composites and the overall rating) is a multistep process. First, the responses to the HHCAHPS Survey items are combined and converted to a 0-100 score, which is called the “Linear Score.” The 0-100 linear score is then adjusted for the effects of patient mix.
To make this adjustment, CMS applies the patient-mix adjustment to quarterly HHCAHPS scores to account for the tendency of certain patient subgroups to respond more positively or negatively to the HHCAHPS Survey. Next, the four-quarter averages of HHCAHPS linear scores are rounded to whole integers using standard rounding rules.
CMS assigns 1, 2, 3, 4, or 5 stars for each HHCAHPS measure by applying statistical methods that analyze the relative distribution of scores. The star rating for each of the four HHCAHPS measures is determined by applying a clustering algorithm to the individual measure scores across home health agencies that minimize differences in scores within star groups and maximizes differences in scores between star groups.
This clustering methodology used is the same methodology that is used for the CMS Part C and Part D star ratings on Medicare Plan Finder, and for Hospital CAHPS on Hospital Compare. For more details, please see the
on https://homehealthcahps.org/Portals/0/HHCAHPS_Stars_Tech_Notes_5_7_15.pdf.
Types of Home Health Agencies Included in Star Ratings
Agencies must have 40 or more surveys completed during the reporting period to receive HHCAHPS star ratings. About two-thirds of home health agencies have HHCAHPS star ratings for this reporting period. Agencies with fewer than 40 completed HHCAHPS surveys do not have enough data to reliably measure true agency performance and, consequently, do not have enough data to assign HHCAHPS star ratings. Caseloads at some agencies may vary, and they may meet the threshold of 40 or more surveys for some reporting periods but not for all reporting periods. CMS continually updates Home Health Compare, and all of its Compare websites, so those HHAs that do not currently have patient experience star ratings may have star ratings in the future.
For more information about the HHCAHPS survey, go to the official HHCAHPS website, https://homehealthcahps.org/search.html.
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