Home Health Providers Fear Star Ratings Will Confuse Patients

The forthcoming government star ratings for home health agencies will include half-star increments, Medicare officials announced on a recent call with providers. The inclusion of half-stars is a response to provider concerns, but many participants on the call said they still have deep worries that the proposed ratings will confuse prospective patients.

The Centers for Medicare & Medicaid Services held an initial call with providers in December to explain the star ratings. They are intended to be similar to the ratings already used for other types of providers, such as nursing homes. The ratings will be based on certain quality measures already reported on the Home Health Compare website, and are meant to be a consumer-friendly way of showing how home health agencies compare with one another. 

After the December call, CMS received feedback and, in response, revised its proposed ratings methodology to include half-stars, according to officials on the call held Feb. 5.


Under the original proposal, 52% of home health providers were projected to receive a rating of three stars out of a possible five. With half-star ratings in play, providers are projected to be more evenly distributed across the different ratings. Under the new methodology, about 80% of HHAs are expected to fall between 2.5 and 4 stars, according to a PowerPoint presentation released in conjunction with the call.

However, several providers said they still worry that consumers will not understand how the stars are awarded and what they represent—for example, that a three-star rating does not mean that the agency is providing mediocre care, but rather that its quality is average compared with other agencies nationwide.

One caller suggested that CMS include plain language on the star rating website explaining that the system is different than star ratings on Amazon, where there is no curve and “every [product] but one could be five-star.”


Providers themselves might perpetuate consumer misunderstanding by referring to the system as the “five-star ratings,” suggested Alan Levitt, M.D., medical officer of the Division of Chronic and Post-Acute Care in the Center for Clinical Standards and Quality at CMS. 

“Describe this as Home Health Compare Ratings, not five-star,” he said. “This is a star rating that really is comparing agency to agency. If we ourselves can get out of the habit of [referring to] five-star, that is a first step.”

Providers also took issue with some of the measures being used to determine the star ratings. For example, some said that agencies will be rewarded for helping patients improve but not for helping them maintain their condition. This undermines the recent landmark Jimmo legal settlement, one caller argued. Jimmo clarified that Medicare should reimburse providers for services to maintain, rather than improve, the health status of certain patients.

CMS is accepting further comments through Feb. 13.

The ratings are scheduled to be released in July and updated quarterly. Providers will receive a preliminary report with their star rating in March, to give them time to address any disputed information with CMS, officials said.

Written by Tim Mullaney