Home Health & Hospice Week

CMS proposes 10 measures for inclusion in star calculation.

Wondering why you should care about your quality measure scores in addition to everything else on your plate? Take a look at CMS’s plans to transition home health agencies to a star rating system based on 10 Home Health Compare measures.

“Consumer research has shown that summary quality measures and the use of symbols, such as stars, to represent performance are valuable to consumers,” the Centers for Medicare & Medicaid Services says on its website. “Star ratings can help consumers more quickly identify differences in quality and make use of the information when selecting a health care provider. In addition to summarizing performance, star ratings can also help home health agencies (HHAs) identify areas for improvement.”

Further: “Home Health Compare Star Rat-ings are calculated using a subset of the home health quality measures that are publically reported on Home Health Compare and are tailored to meet the needs of consumers,” CMS elaborates in a new question-and-answer set about the rating system. “Home Health Compare Star Ratings are quick to read and comprehend and are in a format that is becoming increasingly familiar to consumers.”

Despite being designed to be user-friendly, “even the information on the Compare sites can seem like too much of a good thing,” noted CMS’s Mary Pratt in the Dec. 17 Special Open Door Forum on the new system. The star system is easily understood by consumers, she noted.

Rough seas ahead: “Star ratings have been and continue to be the subject of much controversy in other sectors of the Medicare provider landscape,” notes attorney Ari Markenson with law firm Duane Morris in an educational article.

CMS plans to start using the star rating system some time in 2015, it says. The agency already applies star ratings to nursing homes, physicians and Medicare Advantage plans, and will add them for dialysis facilities and hospitals in 2015 as well.

“To help consumers and their families make choices about where they receive home health care, CMS currently reports 27 process, outcome, and patient experience of care quality measures on the Home Health Compare website,” CMS notes. “The proposed star rating would become an additional measure available on the website.”

The star rating methodology proposed for use on Home Health Compare includes 10 of the 27 currently reported process and outcome quality measures (see box, this page). CMS chose proposed measures based on the following criteria. The measure should:

• apply to a substantial proportion of home health patients and have sufficient data to report for a majority of home health agencies;

• show a reasonable amount of variation among home health agencies and it should be possible for a home health agency to show improvement in performance;

• have high face validity and clinical relevance; and 

• be stable and not show substantial random variation over time.

Brace For Summer Debut

CMS aims to publicly report the first Home Health Compare Star Ratings in the summer of 2015, it says in the Q&A. “HHAs will have an opportunity to see their Home Health Compare Star Ratings several weeks prior to posting on the Home Health Compare website when a preview report is posted in their CASPER folder,” CMS explains.

The exact timing will depend on the number of comments received and amount of work to be done, Pratt noted in the call.

Payment: The five-star rating will not affect HHA payments at this time, CMS says in a fact sheet.

Do this: “Home health providers should keep their eyes and ears open to CMS pronouncements on the ratings system and be sure they participate in feedback to the agency as the process develops,” Markenson advises.

You can submit comments via email to HHC_Star_Ratings_Helpdesk@cms.hhs.gov. “Your feedback to this mailbox will be considered in finalizing the star rating methodology,” Pratt said in the Open Door Forum.

“Please send in your concerns so we can take a better look at it,” a CMS rep urged. 

Note: More information, including rating calculation details, a link to the Q&A set and the slides from the call are at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQISpotlight.html — scroll down to the “Downloads” section.