Home health gets the star treatment with quality rating updates

The Affordable Care Act of 2010 calls for transparent, easily digestible information on provider quality to be publicly reported and widely shared. Therefore, the Centers for Medicare and Medicaid Services (CMS) extended star ratings to home health agencies (HHAs) on Home Health Compare (HHC) in July 2015 to provide home health care beneficiaries with a summary quality measure in an accessible format.

By supporting consumer choice and encouraging provider quality improvement, public reporting will remain a mainstay for improving health care quality. CMS currently reports 27 process, outcome and patient experience of care quality measures on the HHC website to equip patients and their families with the right tools to make choices about home health care.

How Are Star Ratings Calculated?

There are two types of star ratings:

1) The Quality of Patient Care Star Rating – This rating probes nine specific evidence-based process and outcomes measures for each home health agency (assuming that the agency is not excluded) such as timely initiation of care, improvement in patients' functional status and hospital readmissions. The measures are calculated into a composite score and star rating, which are usually calculated quarterly:

• CMS ranks all HHA providers reporting and then divides them into 10 ranked deciles for each measure.
• Each HHA receives a score (.5 to 5) based on which ranked decile it is in.
• Each score is compared to a national agency average on that measure, and if there is a statistical difference, the score will be adjusted.
• For each agency, the adjusted scores are averaged to reach a composite score (.5 to 5). These are then translated into stars.

2) Patient Survey Star Ratings – Introduced on January 28, 2016, these ratings incorporate the patient experience of care measures based on Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). These surveys reflect patients' views and examine the communications between healthcare staff and patients explaining how patients take care of themselves and whether the staff exhibited courtesy, understanding and respect. The questionnaires also examine whether the staff checked patients' prescriptions for side-effects and properly explained dosing instructions.

Prior to this public reporting, HHAs were given preview reports to review their HHCAHPS data and their HHCAHPS star ratings. These reports are posted on the HHCAHPS website and the agencies can access their data by logging in.

If an agency does not have at least 20 episodes during the 12-month reporting period or has been certified for at least six months, that agency will not be included in the star ratings.

How Do They Apply to Recent Regulatory Changes?

Over the past year, CMS has not only made changes in how the Home Health Star Ratings are calculated, but have also have added a new rule around the use of the Star Ratings.

Under the IMPACT Act, CMS is required to regulate the use of a quality and resource measurement system to inform patients in their selection of a post-acute care provider. CMS has proposed regulations to hospitals, nursing facilities, and home health agencies requiring them to use a measurement system such as the CMS Star Ratings to support the required Conditions of Participation.

Given the important role home health serves in the post-acute care of LEJR patients, hospitals and HHAs continue to collaborate under the Comprehensive Care for Joint Replacement (CJR) model. Prior to the CJR final rule, CMS proposed to only waive the homebound requirement for those home health agencies that have a quality rating of three or more stars. To date, CMS has not yet required a certain star rating for home health agencies to receive a homebound waiver under the BPCI program and the CJR program does not include a homebound waiver.

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