Conflicting Home Health Star Ratings Lead to Confusion

Between two recently introduced ways of rating home health agencies, those looking for home health care might find conflicting results.

Take Brookdale Senior Living, for example. Four of its home health agencies in Florida, North Carolina, Ohio and Rhode Island earned a top score of five stars based on data they submitted related to quality of patient care. Meanwhile, Medicare also posts stars relating to how patients rate agencies once their care is complete, and here, these four Brookdale agencies received just two stars or less.

The discrepancy is hardly uncommon, as one in five agencies had clinical and patient ratings that differed by two or more stars, according to a Kaiser Health News analysis of government records.


In January, the Centers for Medicare & Medicaid Services (CMS) introduced the first “Patient Survey Star Ratings,” which are meant to reflect patients’ experiences with home health agencies and examine how workers treated them. CMS already had in place its Quality of Patient Care star ratings, which summarize home health agencies’ performance on nine quality measures that indicate how well they help their patients in maintaining or regaining important functional abilities and how often they adhere to evidence-based processes of care.

In the patient survey ratings, 2,152 earned five stars, but just 286 agencies rated for clinical quality received the maximum five stars as of January. Only 30 agencies received five stars from both rating systems, including VNA Space Coast in Melbourne, Florida and Cottage Home Health in Galesburg, Illinois, according to the Kaiser analysis.

“We’re really talking about very different sets of metrics,” Teresa Lee, director of the nonprofit research group Alliance for Home Health Quality and Innovation, told NPR. “It’s unfortunate, but maybe it’s the truth that patient experience and clinical quality of care do not go hand in hand.”


And CMS said the difference between the two star ratings shouldn’t confuse patients.

“CMS stresses that website users should look at all of the different types of measures available for a given provider type, including for home health care agencies,” CMS said in a statement to NPR. “By providing both clinically based and survey-based measures, CMS hopes to make available to the public a range of perspectives and information that consumers can evaluate to help inform their decision about an agency.”

Another factor contributing to the contradictory results could be that fewer than 100 patient surveys were returned per agency. Medicare didn’t assign stars to agencies if less than 40 surveys were returned, and its Home Health Compare website tells consumers to take the scores “with caution as the number of surveys may be too low to accurately tell how an agency is doing.”

But getting patients to complete the surveys has been challenging, Kristin Puckett, a Brookdale spokesperson, told NPR.

“It is important to point out that our potential population has an average age of 86 and often relies on family members, powers of attorney and/or guardians to complete [the survey],” she said.

It’s not clear how many patients use Medicare’s star ratings to select a home health agency, and whether they understand them if they do.

“If you have patients who are very sick, the question is to what extent will they be in a position, because of their health, to really look extensively at this kind of information,” Lee told NPR.

Written by Kourtney Liepelt

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