Home Health & Hospice Week

About half of agencies will fall in 3-star range.

Home health agencies are disappointed that CMS isn’t delaying its plan to unveil star ratings on Home Health Compare starting this summer.

HHAs had major complaints about the clumping of agencies around the three-star mark (see Eli’s HCW, Vol. XXIV, No. 2). As a result, the Centers for Medicare & Medicaid Services has changed its star rating methodology in multiple ways, it said in the Feb. 4 Special Open Door Forum on the topic.

One big change is that agencies will be assigned ratings that include half-stars. Another is that agencies will be sorted into 10 categories instead of the originally proposed four.

However: Despite changes, the largest portion of agencies still will fall into the 3- or 3.5-star category, CMS revealed — 49 percent according to estimates based on 2013 data. That compares to 52 percent of agencies in the 3-star category under the previous methodology.

CMS also stuck with its originally proposed 10 measures used to calculate the star rating, despite protests that some measures are out of an agency’s control and that the measures reward improvement rather than stabilization.

Plus: CMS revealed that it is developing a star ratings methodology for HH CAHPS data. CMS won’t include CAHPS data in the first round of star ratings, the agency allowed. But it “could eventually be combined with quality measure data,” according to the forum slides.

The National Association for Care & Hospice “has the same concerns with this proposal as it did with CMS’ initial proposal,” the trade group says in its member newsletter. 

“The revised methodology continues to divide agencies in sections — now ten rather than five — even when performance variation between providers may be slight,” NAHC says. “This is compounded by ranking agencies on a ‘curve’ that moves agencies towards a 3 star rating.”

What Do Star Ratings Mean For VBP?

Don’t expect value-based purchasing (VBP) to necessarily use the same measures as the star ratings, CMS cautioned in an updated question-and-answer set. “The measures proposed for inclusion in the Star Ratings were selected to support consumer choices among providers,” CMS says in a Q&A. “The selection of measures to be used for value-based purchasing would presumably use different criteria and would therefore require a separate evaluation process.”

Timeline: Expect to see preview reports of your star rating in late March. Then, “agencies will have several weeks to review and provide feedback on any data errors identified that affect the final star rating,” CMS noted in the forum. 

Note: See more information on the new website for the star rating system at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings.html.