Public Payers News

Star Ratings System Created for Medicaid Home Health Services

CMS announced an important improvement for Medicare and Medicaid home health services. A star ratings system has been developed on the Home Health Compare website.

By Vera Gruessner

- Earlier this week, the Centers for Medicare & Medicaid Services (CMS) established a final rule that alters the Medicaid home health services definition to include additional requirements for home care services which expands beyond medical supplies and equipment. The new rule from CMS is expected to offer more guidance on the requirements behind the home health benefit. The new ruling is also meant to aid in streamlining access to needed supplies among beneficiaries.

Home Health Compare Resource

Along with Medicaid home health services, other benefits that the Medicaid program offers include inpatient and outpatient hospital services, nursing facility and physician services, family planning, laboratory and X-ray, tobacco cessation counseling, pediatric care, and diagnostic services.

Yesterday, CMS announced another important improvement for Medicare and Medicaid home health services. A star ratings system has been developed on the Home Health Compare website in which patients can provide a view of their healthcare experience.

The star ratings system is called the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey. The Home Health Compare resource is meant to assist beneficiaries in choosing Medicare-certified medical facilities.

The ratings system allows users (consisting of patients, family, or friends of patients) to choose anywhere from one to five stars to report their experience on a particular home health agency. There are no half stars provided through the rating system because it was determined half-star ratings did not provide any statistical significance in measuring quality of care.

“The Patient Survey star ratings are derived from the home health patient surveys. The HHCAHPS Survey is uniformly implemented by independent CMS-approved survey vendors,” CMS reported on its website. “HHCAHPS star ratings are assigned in a way that minimizes differences within groups and maximizes differences between groups. The clustering algorithm empirically determines the number of home health agencies in each star rating category independently for each HHCAHPS measure.”

“CMS assigns 1, 2, 3, 4, or 5 stars for each HHCAHPS measure by applying statistical methods that analyze the relative distribution of scores. The star rating for each of the four HHCAHPS measures is determined by applying a clustering algorithm to the individual measure scores across home health agencies that minimize differences in scores within star groups and maximizes differences in scores between star groups.”

“Agencies must have 40 or more surveys completed during the reporting period to receive HHCAHPS star ratings. About two-thirds of home health agencies have HHCAHPS star ratings for this reporting period. Agencies with fewer than 40 completed HHCAHPS surveys do not have enough data to reliably measure true agency performance and, consequently, do not have enough data to assign HHCAHPS star ratings.”

Currently, the Home Health Compare website includes information on more than 11,000 home health agencies and more than 6,000 of these include the patient care experience star rating system.

Patients are able to access a summary of the patient care experience surveys for the agencies providing Medicaid home health services. The star ratings are based on nine healthcare quality measures to help patients regain necessary abilities.

“Having the HHCAHPS Survey star ratings on Home Health Compare helps patients and their families make more informed health care decisions and encourages home health agencies to strive for higher levels of quality and patient experience,” CMS Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., MSc, said in a public statement. “We hope patients and their families find this information helpful and visit our other provider comparison websites.”

The star ratings system is another example of how CMS is dedicated to improving transparency within the healthcare industry for the patient community and empowering patients and their families to make quality healthcare decisions.

Other rating programs set up by CMS include Nursing Home Compare, Physician Compare, Dialysis Compare, and Hospital Compare. Also, the Medicare Plan Finder assists beneficiaries in choosing the best Medicare plan for them during the open enrollment period.

The star ratings system is displayed in the form of a 34-question survey that asks patients about their home health experience and viewpoints on their medical care. The website also displays how each home health agency compares to state and national averages in order to better inform patients and caregivers on the best options for their home care.

CMS also encourages families and patients to speak with healthcare providers when choosing a home health agency and to focus on multiple factors for their home care needs alongside of the star ratings system.

As federal agencies, healthcare providers, and health insurance companies partner toward reducing the rising costs of care, improving the quality of medical services around the nation, and boosting the health outcomes throughout the patient community, these type of resources will remain key toward strengthening transparency and advancing healthcare decision-making.