Home Healthcare + Star Ratings = Controversy

Like nursing homes, physician groups,dialysis centers and Medicare Advantage plans before them, CMS is now rating the quality of care delivered by home healthcare agencies (HHAs). As the chart shows, there are opportunities to improve the quality of care — in terms of outcomes and processes — at HHAs.

As one would expect with any new program, there are disagreements about the program’s methodology and metrics.

• Each home health agency received a single, summary star rating based on their performance on nine (out of nearly 30) process-related and outcomes-related quality measures already posted on Home Health Compare, the CMS’ consumer-facing comparison tool. Basing ratings on a minority of the evaluation criteria might present an inaccurate picture of performance.

  The three process measures include 1) timely initiation of care, 2) education provided to patients or caregivers about their medications and 3) the administration of flu shots. HHAs, like other types of facilities, find it easier to improve process measures.

  Outcomes measures include: 1) getting in and out of bed; 2) walking or moving around; 3) breathing; 4) less pain when moving around, 5) bathing on their own, and; 6) hospital admissions. As the age of the average HHA patient is approximately 85 years old, improving outcomes is challenging.

• CMS allots only a certain number of facilities into each category. For example, up to 2.6% can receive five stars and up to 0.1% can receive one star, while up to 22.6% can receive three stars. While grading on a fixed curve prevents rating inflation, it also might force the agency to assign different ratings based on minor differences in performance.

Regardless of the controversy, the implications for healthcare manufacturers are clear. As they market products for use in the home, data-driven sales and marketing messages should demonstrate how the products improve HHA’s performance on the measures CMS includes in the program.

In our last newsletter, we focused on CMS’ Quality Improvement Program for dialysis centers as a model for other pay-for-performance models. The HHA program provides another benchmark for developing pay-for-performance programs in other care settings.

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