How Does Medicare Measure Home Health Quality? | myNEXUS®

07 . 10 . 2020

Star Rating

Medicare built the Home Health Compare (HHC) “star ratings” website on Medicare.gov as a key tool to help consumers choose a home health care provider. 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 upon Medicare’s Outcome and Assessment Information Set (OASIS) and Medicare claims data. Medicare-certified Home Health Agencies are required to report OASIS (patient quality of care) measures. OASIS-D2, implemented in 2019, is the current version of the OASIS data set. Data are collected at the following time points:

  • Start of care
  • Resumption of care following inpatient facility stay
  • Recertification within the last five days of each 60-day recertification period
  • Other follow-ups during the home health episode of care
  • Transfer to an inpatient facility
  • Death at home
  • Discharge from agency

Assessments at each of these time points, except for transfer to inpatient facility and death at home, require the clinician to have an in-person encounter with the patient during a home visit.

The OASIS tool is lengthy and measures quality across multiple domains: effectiveness, efficiency, equity, patient-centeredness, safety, and timeliness1. More specifically, in addition to collecting patient demographic data, it also captures:

  • Patient history
  • Diagnoses
  • Medications
  • Physical exam results
  • Health care utilization
  • ADLs/IADLs
  • Vaccinations
  • Living conditions
  • Goals of care
  • Self-care

From this data, seven quality of care measures are derived and are used to calculate, in part, the Quality of Patient Star Rating. The seven measures are:

  1. Timely Initiation of Care (process measure)
  2. Improvement in Ambulation (outcome measure)
  3. Improvement in Bed Transferring (outcome measure)
  4. Improvement in Bathing (outcome measure)
  5. Improvement in Shortness of Breath (outcome measure)
  6. Improvement in Management of Oral Medications (outcome measure)
  7. Acute Care Hospitalization (claims-based) (outcome measure)

The Patient Survey Star Rating is the second HH Star Rating and is based upon the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) star ratings.

The HHCAHPS star ratings were created using data from four HHCAHPS measures publicly reported on Home Health Compare.

Three Composite Measures:

  • Care of patients
  • Communication between providers and patients
  • Specific care issues

One Global Measure:

  • Global measure Overall rating of care (question 20)

In addition to star ratings for the four HHCAHPS measures, the HHCAHPS summary star rating is also provided. The HHCAHPS summary star rating is calculated from the three composite star ratings and the single global measure.

The limitations of Home Health Compare

Medicare’s HH Compare methodology is geared towards the patient and may not adequately support managed care network design. For example, payers may wish to overemphasize such measures as Timely Initiation of Care and Acute Care Hospitalization when targeting agencies for network participation. However, the overall Star Rating is not designed to support this more focused approach as it doesn’t assess these areas of performance Additionally, the HH Compare Methodology does not measure affordability or overall impact to a payer’s total cost of care – two important domains to consider for most payers when designing their networks.

Additionally, HH Compare should only be used as a proxy to estimate a Provider’s performance in the home, there is no direct correlation between a Provider’s results in HH Compare, and that Provider’s actual outcomes specific to a payer’s membership.

Lastly, published data available in HH Compare represents Provider’s performance which, in most cases, took place more than a year prior to the current day. Given these limitations of Home Health Compare, most managed care organizations have had to build or buy a quality and cost assessment methodology to build a high performing network. In this regard, myNEXUS’s proprietary provider assessment methodology may be very helpful as it was designed with the managed care organization’s objectives in mind. Should you be interested in learning more, you can check out our content library, give us a call (866.828.0037), or send us an email.