Home Health & Hospice Week

Be aware that your star rating may easily change next time.

Many more home health agencies fall into the five-star group under Home Health Compare’s new “Patient Survey Results” tab. But HHAs still aren’t sure how to best use their results.

Background: Last summer, the Centers for Medicare & Medicaid Services began displaying star ratings under the “Quality of Patient Care” tab on Home Health Compare. CMS bases those ratings on nine measures (see sidebar, p. 43). When CMS launched the quality star ratings, it promised a followup with Patient Survey star ratings in January 2016 based on five measures drawn from HHCAHPS data (see sidebar below).

Now CMS has followed through on its promise, posting HHAs’ new Patient Survey ratings Jan. 28 based on data from July 2014 to June 2015. HHAs were able to see their ratings in preview reports starting last October.

Remember, HH CAHPS data for agencies has been available on HH Compare before, reminds law firm Arnall Golden Gregory in a recent analysis. But they were available for individual measures, not as a composite star rating.

5-Star Club Gets Less Exclusive In Patient Satisfaction Category

Under the Quality of Patient Care category, only about 2 percent of HHAs achieve a five-star rating. Ten states have no five-star agencies, and many other states have only a few, notes Fazzi Associates in analysis posted on its website.

Big difference: But under the Patient Survey category, 2,152 out of 5,743 HHAs with summary star ratings landed in the five-star category — 37 percent, Fazzi notes.

Less than half of Medicare-certified HHAs have patient survey data displayed, mainly due to the fact that they don’t report at least 40 completed Home Health CAHPS surveys over the four-quarter reporting period.

However: HHAs with fewer than 40 completed surveys will still have their HHCAHPS data publicly individually reported on the Home Health Compare website, pointed out CMS’s Lori Teichmann in the Jan. 27 Open Door Forum for home health. “In other words, star ratings [are] an additional feature for home health CAHPS information on Home Health Compare and [do] not replace any current ... CAHPS data displayed.”

CMS is hoping that publicly reporting quality and patient satisfaction data will affect how patients find agencies. “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,” says CMS Deputy Administrator and Chief Medical Officer Patrick Conway in a release.

Adding HHCAHPS information to Home Health Compare “is the latest example of how CMS is committed to transparency and helping patients and their family members make informed health care decisions through an initiative to simplify the quality of care information across all CMS Compare websites,” CMS continues. “It also supports the larger effort across the Department of Health and Human Services (HHS) to build a health care system that delivers better care, spends health care dollars more wisely, and results in healthier people.”

Use Star Rating Status Wisely

HHAs are still trying to figure out how to best utilize the star rating information. Agencies with top ratings can, of course, use the information to boost their reputation and name recognition.

For example: “ContinuCare HealthServices, a home health provider and subsidiary of the Erlanger Health System, earned a 5-star rating, the highest possible,” the Chattanooga, Tenn.-based agency crows in a release issued Feb. 1. “Continu-Care is one of only three home health agencies in the Chattanooga area to have received the highest rating in patient experience from CMS,” says the release, which also gives some background on HHCAHPS and HH Compare.

Pro: For HHAs that did not earn five stars in the Quality of Patient Care category but did in the Patient Survey category, they can use their new Patient Survey 5-star status to counteract competitors’ claims of superior quality.

Con: If you were one of the few agencies that scored in the 5-star category under Quality of Patient Care, the much larger pool of 5-star agencies in the Patient Survey category may dilute your message about superior quality.

Con: Also, remember that if you make a big point of advertising your 5-star rating and then drop out of the top category in a future data update, you may have a lot of explaining to do.

Dropping out of that category may happen more easily than you think. For example, even if your scores stay exactly the same, your rating may change. “Because the cluster distribution of agencies is recomputed with each 12-month public reporting period, the scores that designate each Star Rating cluster may change,” explains education resource vendor The Home Care Institute on its website.

“For this reason, an agency’s Star Rating may change, even though its linear scores stay the same.”

Slight scoring changes may also easily lead to a category drop. HHCAHPS scores in general are tightly clustered at the top end of the score range for most of the measures, so “a change of one percentage point on a particular HHCAHPS measure may be enough to move that agency from one cluster category to another,” The Home Care Institute adds.

To do: The methodology for improving your Patient Survey scores likely will differ from what you do to boost your Quality of Patient Care scores, experts note. You’ll have to spend time focusing on client interaction issues in addition to underlying clinical and operational improvements.

“To be successful with the star rating program, agencies must continue to focus on quality and customer service,” The Home Care Institute advises. “Clinicians need to be aware about the significance of this visual indicator and how they contribute to results. Whether it’s a movie, restaurant, hotel or home health agency, consumers demand high quality services.”

On the horizon: Working to improve your star ratings goes beyond marketing, industry veterans say. Watch for coming star rating impacts under Value-Based Purchasing and Medicare Advantage contracting, they predict.