Home Health Compare Quality of Patient Care Star Ratings

Home Health Compare Quality of Patient Care Star Ratings

What Are Star Ratings?
Consumer research has shown that summary quality measures and the use of symbols, such as stars, to represent performance are valuable to consumers. Star ratings can help consumers more quickly identify differences in quality and make use of the information when selecting a health care provider. In addition to summarizing performance, star ratings can also help home health agencies (HHAs) identify areas for improvement. They are useful to consumers, consumer advocates, health care providers, and other stakeholders when updated regularly to present the most current information available.

Why Star Ratings for Home Health?
The Affordable Care Act calls for provider-specific performance information about quality measures to be made available to consumers through standardized websites.  In order to provide consumers with a summary quality measures in an accessible format, CMS has published a Quality of Patient Care Star Rating for home health agencies on the Home Health Compare website.

This is part of CMS’ plan to adopt star ratings across all Compare websites on Medicare.gov. Star ratings are currently publicly displayed on Nursing Home Compare, Physician Compare, the Medicare Advantage Plan Finder, Dialysis Facility Compare, and Hospital Compare.

Public reporting is a key driver for improving health care quality by supporting consumer choice and incentivizing provider quality improvement. CMS currently reports 29 process, outcome, and patient experience of care quality measures on the Home Health Compare website to help consumers and their families make choices about where they receive home health care. The Quality of Patient Care Star Rating summarizes 9 of those measures into a single star rating available to consumers on the website.

Which HHAs Receive Quality of Patient Care Star Ratings?
All Medicare-certified HHAs are eligible to receive a Quality of Patient Care Star Rating. Currently, HHAs must have data for at least 20 complete quality episodes for a measure to be reported on Home Health Compare. Episodes must have a discharge date within the 12-month reporting period regardless of admission date. To have a star rating computed, an HHA must have reported data for at least 5 of the 9 measures used in the calculation.

How Were the Measures for Inclusion in Quality of Patient Care Star Rating Selected?
The Quality of Patient Care Star Rating methodology includes 9 of the 29 currently reported process, outcome and patient experience quality measures. The measures included in this rating were chosen based on the following criteria:

1. The measure should apply to a substantial proportion of home health patients and have sufficient data to report for a majority of home health agencies.
2. The measure should show a reasonable amount of variation among home health agencies and it should be possible for a home health agency to show improvement in performance.
3. The measure should have high face validity and clinical relevance.
4. The measure should be stable and not show substantial random variation over time.

Based on these criteria, the measures below were selected for inclusion.

How Were the Quality of Patient Care Star Ratings Calculated?  
The methodology for calculating the Quality of Patient Care Star Rating is based on a combination of individual measure rankings and the statistical significance of the difference between the performance of an individual HHA on each measure (risk-adjusted, if an outcome measure) and the performance of all HHAs. An HHA’s quality measure values are compared to national agency medians, and its rating is adjusted to reflect the differences relative to other agencies’ quality measure values. These adjusted ratings are then combined into one overall star rating that summarizes performance across all 9 individual measures. Further details on the methodology are presented in the Quality of Patient Care Star Ratings Methodology Report that is posted on CMS’ Home Health Star Ratings web site:
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings.html.

What is the Distribution of the Quality of Patient Care Star Ratings?
The Quality of Patient Care Star Ratings released in July 2015 are based on Home Health Compare data for calendar year 2014. Table 1 shows the distribution of ratings across all HHAs. The number of agencies with an overall rating of one star is less than one-tenth of one percent, while the number of HHAs receiving five stars is less than three percent. Nearly half of all agencies fall in the three to three and one-half star rating range.  

Table 1: Distribution of Quality of Patient Care Star Ratings, July 2015
(Data for CY 2014)

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