By Jackie Birmingham, RN, MS, vice president, emeritus, of clinical leadership, Curaspan.
The Affordable Care Act calls for provider quality to be publicly reported and widely shared. As a result, the Centers for Medicare and Medicaid Services (CMS) extended star ratings to home health agencies (HHAs) on Home Health Compare (HHC) in 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 pillar for improving healthcare quality. Currently, CMS 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 healthcare.
Calculating the 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 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 typically calculated on a quarterly basis and include:
- CMS rankings of all HHA providers reporting which is then divided into 10 ranked deciles for each measure.
- Each HHA receives a score (.5 to 5) based on its ranked decile.
- 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, adjusted scores are averaged to reach a composite score which are then translated into stars.
2) Patient Survey Star Ratings –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 on a variety of issues including whether the staff checked patients’ prescriptions for side-effects and properly explained dosing instructions.
Additionally, surveys examine the communications between healthcare staff and patients and whether the staff exhibited courtesy, understanding and respect.
Previously, HHAs were given preview reports to review their HHCAHPS data and their HHCAHPS star ratings. Agencies can access their data in these reports by logging in to the HHCAHPS website.
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.
Applying Recent Regulatory Changes
Over the past year, CMS has made a variety of changes including adding 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 like the CMS Star Ratings to support the required Conditions of Participation (CoP).
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 home health agencies that have a quality rating of three stars or more. Currently, CMS has not 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.