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Public reporting is a key driver for improving health care quality by supporting consumer choice and incentivizing provider quality improvement. To help consumers and their families make choices about where they receive home health care, CMS currently reports 27 process, outcome, and patient experience of care quality measures on the Home Health Compare website. The proposed star rating would become an additional measure available on the website. Several alternative methods of calculating the star rating were considered, borrowing from the methods used for other care settings, such as nursing homes, dialysis facilities, and managed care. After consideration of these alternatives, we propose the methodology below for HHC Star Ratings.
Quality of care ratings, first introduced in July of 2105 are based on OASIS and Medicare claims data. Quality score calculations use 9 quality-of-outcome metrics and, in general, reflect how much patient conditions improve and how often they make a hospital visit. The way CMS calculates and report the star ratings now is based on input from stakeholders and ongoing data analysis.
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Forward-thinking agencies know that high star ratings give them an edge over the competition. Referral sources are motivated to choose post-acute providers that prevent readmissions while keeping costs down. It’s time to act with a structured performance improvement plan. Based on the combination of criteria, this measure was also eliminated from consideration. On October 12, 2016, the formula CMS uses to rate health insurance providers was adjusted.
The right technology solution also improves care outcomes and increases efficiency. If you think you have the right software but still aren’t seeing the ideal performance, think about how the staff uses their tools. Agency leaders should expect renewed interest from providers and referral sources in Care Compare. The April 2022 update will reflect performance on OASIS assessments and HHCAHPS surveys from October 1, 2020, through September 30, 2021. To predict what the new ratings might say about your agency, think back to how the business looked at the end of 2020 and the beginning of 2021.
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Completed episodes are paired with 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 Downloadssection below.
Getting your OASIS and claims submissions right the first and every time is a big part of this equation. Remember, your quality score calculations use OASIS quality-of-outcome metrics reflecting how much patient conditions improve. Medicare assigned clinical star ratings based on agencies’ performance for patients receiving care from April 2012 through June 2015.
What Are Home Health Star Ratings?
Ideally, care quality and patient satisfaction results are related, and star ratings will be similar. Similar to the recent health insurance plan fiasco, consumer confusion will occur if the value of the home health stars suddenly change. However, currently there is other confusion plaguing home heath star ratings. Appendix B provides information about the stability of HHC star ratings over time when using the proposed methodology.
Based on this, all four process measures and five OASIS-based outcome measures were proposed for inclusion in home health star ratings. As for the two claims-based measures, the year-to-year correlations were more modest. Only one of these claims-based measures, “Acute Care Hospitalization,” was initially proposed for inclusion in star ratings, because reducing potentially avoidable hospital use is an important national goal.
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 theHHCAHPSwebsite. CMS has said that Care Compare will once again reflect claims-based measures starting in July 2022. Nursing Home Compare allows consumers to compare information about nursing homes. It contains quality of care and staffing information for all 15,000 plus Medicare- and Medicaid-participating nursing homes. One of the industry experts I learn from every time we speak is Ginny Kenyon, principal at Kenyon Home Care Consulting.
Patient satisfaction “summary” stars were based on surveys of people who received care from June 2014 through June 2015. This chart includes California agencies whose patient experience stars were based on fewer than 100 surveys or had other data shortcomings that made them unreliable. The data, published in January, is the most recent. An HHA’s quality measure values are compared to national averages, and their rating is adjusted to reflect the differences relative to other agencies’ quality measure values.
Talk to your doctor or other health care provider about the information on Nursing Home Compare. Most of the candidate measures met the criteria of applicability to the home health population and ability to report for most home health agencies. One process measure, “Heart Failure Symptoms Addressed,” and one outcome measure, “Surgical Wound Healing,” did not meet an acceptable threshold for this criterion. 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.
Set a reminder on your calendar to check updates quarterly. Another trend during this time was shifting to remote operations. If your business went through a restructure, it’s possible that internal process changes affected OASIS measures. Three or three and a half-star agencies are considered average.
Instead, get laser-focused on a single area where you can see change quickly and work on that. The Medicare Conditions of Participation require agencies to have Quality Assurance, and Performance Improvement plans in place. Use this opportunity to craft a QAPI project to improve your OASIS accuracy or care outcomes. According to Medicare.gov, CMS selected these measures for a general overview of HHA performance on indicators that apply to most patients. This recent statewide survey found that one in four Californians had trouble paying a medical bill in the last 12 months.
Have the chance to learn about how the star ratings were developed. CHCF commissioned a study that listens deeply to Black Californians talking about their experiences with racism and health care. This report summarizes in-depth interviews with 100 Black Californians and 18 focus groups, as well as a statewide survey of 3,325 adult Black Californians. I’m picky when it comes to eating out, choosing a restaurant.
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Small agencies may not have a star rating if they cannot consistently generate sufficient data. Both sets of home health star ratings are available on Home Health Compare, a subsidiary website of Medicare.gov. The quality stars are meant to summarize or rate care providers.
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