Top States for Highly Rated Home Health Agencies

The public now can evaluate Medicare-certified home health agencies using a five-star system, with the ratings posted online as of Thursday. While the vast majority of HHAs received around three stars, as expected, the ratings also illuminate some aspects of the industry that might be more surprising—including which states are top of the pack and which have the fewest top-rated providers.

The Home Health Compare Quality of Patient Care Star Ratings are based on an agency’s relative performance on nine quality measures tracked by the Centers for Medicare & Medicaid Services (CMS), including timeliness of care and frequency of hospital admissions. They are similar to the CMS star ratings for nursing homes and other providers.  

“Adding star ratings to Home Health Compare is another step forward in our continuing efforts to empower consumers by providing more information to help them make health care decisions, while also encouraging providers to strive for higher levels of quality,” said Dr. Patrick Conway, acting principal deputy administrator for CMS and deputy administrator for innovation and quality, in a prepared statement.

The ratings are distributed according to a curve, meaning that the majority of agencies are in the middle-of-the-pack while five-star and one-star ratings are rarer outliers.

In fact, only six agencies received a single star in this first release, while 239 agencies received five stars, according to a Kaiser Health News analysis. More than 9,300 agencies nationwide received a rating, and 46% received three or three-and-a-half stars. The ratings are to be updated quarterly.

Home health providers and other industry stakeholders have expressed concern that consumers will not understand that, because they are comparative, they are different than star ratings used for hotels and other products.

While a consumer might view a three-star rating as mediocre, CMS takes a different view. The ratings distribution for this first round shows “a large proportion of home health agencies are performing reasonably well,” Dr. Kate Goodrich, director of CMS’ quality measurement program, told KHN.

When it comes to providers receiving four or more stars, Medicare beneficiaries in certain states will have more options, KHN determined. These are the states where a third or more of rated HHAs scored four or more stars:

  • Alabama
  • California
  • Florida
  • Maryland
  • New Jersey
  • Pennsylvania
  • Rhode Island
  • South Dakota
  • Utah
On the other hand, these are the states where four out of 10 agencies or more received less than three stars:
  • Alaska
  • Arkansas
  • Minnesota
  • Ohio
  • Oregon
  • Texas
  • Wyoming
  • District of Columbia
Some may be surprised to see Minnesota ranked near the bottom, as the state often appears at the top of rankings for senior care. For instance, it was No. 1 for long-term services and supports on a 2014 scorecard from AARP, The SCAN Foundation and the Commonwealth Fund. Conversely, Alabama ranked second-to-last on that list.
But providers point to flaws in the ratings system that could be unduly punishing certain agencies. For example, some of the quality measures used for calculating the ratings are based on how much a patient has improved. Agencies like Chicago-based Medex Home Healthcare, which takes on many patients whose conditions do not allow for improvement, might therefore get dinged, Medex President and CEO Nelson Hodogbey told The Chicago Tribune. Medex received one-and-a-half stars.
Whatever is behind their low ratings, agencies on this end of the spectrum could see referrals from hospitals and other providers start to dry up—and ultimately this could force them out of business, KHN reported.
In terms of other trends KHN identified in the ratings, religiously affiliated and other not-for-profit providers tended to score higher. This is not to say that large, for-profit providers were shut out, though. Twelve home health agencies affiliated with Brookdale (NYSE: BKD)—the largest senior housing company in the country—received five stars.
In January, CMS plans to roll out a second, separate set of star ratings for HHAs, based on consumer input.

Written by Tim Mullaney