Experts Recommend Changes to Home Health Star Ratings

There’s plenty of room for improvement when it comes to the methodology, clarity and accessibility of Home Health Quality of Patient Care star ratings.

That was the consensus among the Home Health Quality of Patient Care Star Ratings Technical Expert Panel (TEP), convened by Abt Associates in early May. The Centers for Medicare & Medicaid Services (CMS) contracted with Abt to convene the panelists, a group of home health executives, consultants and academics tasked with reviewing the first year of data on the performance of the Quality of Patient Care star ratings—as well as making recommendations for revising them.

The Quality of Patient Care star ratings, separate from the Patient Survey Star Ratings, summarize home health agencies’ performance on nine quality measures that indicate how well they help their patients in regaining or maintaining important functional abilities, and how frequently they adhere to evidence-based processes of care.


Among their recommendations, the TEP proposed revamping the way the Quality of Patient Care star ratings are calculated, reconsidering which data sources are included in the rating methodology and clarifying the ratings’ meaning for consumers.

Keeping end-goals in mind

Specifically, the TEP expressed concern that the current methodology for calculating the star ratings may not be properly taking into consideration the diversity of home health patients, including patients whose end goal is to remain stable, not to improve.


The recommendation to explore this distinction has been met with enthusiasm from industry stakeholders.

“I feel this will truly allow home health care agencies to be accurately differentiated from each other,” Michele Berman, director of rehabilitation at BAYADA Home Health Care, told Home Health Care News. “Of all the recommendations, this is the biggest win.” BAYADA is a privately held, New-Jersey based company that operates in 22 states.

The TEP also raised concerns about consumers’ general understanding of the Quality of Patient Care star ratings, noting that while the ratings are a tool meant to help patients and their families pick a home health agency, consumers may confuse the ratings with the Patient Survey star ratings, and they may not realize the Quality of Patient Care star ratings are essentially rated on a curve, so there aren’t 4- or 5-star agencies in every market.

The experts also poked holes in the star ratings’ methodology. The payer mix at a home health agency appears to be driving the agency’s star ratings performance, the TEP explained. Specifically, patients who are the easiest to manage are reimbursed at the highest Medicare fee-for-service rates, and agencies that serve patients who are more difficult to treat typically have lower ratings.

These trends may disincentives providers to care for difficult-to-treat populations, the TEP said.

“I do absoltely agree that we can see that, and that is absolutely worth exploring,” Gina Mazza, partner and director of regulatory and compliance services at Fazzi Associates, told HHCN.

The star ratings should also incorporate changing payment and care delivery initiatives, such as value-based purchasing, the TEP said. New measures emerging from the IMPACT Act would be beneficial for inclusion in the Quality of Patient Care star rating methodology, the TEP explained.

Mazza agreed.

“I think that makes a lot of sense,” she said. “The burden on agencies is tremendous if they have to keep track of different programs with different requirements, even though they all have the same goal.”

Clearing up confusion

Though there has been some confusion among consumers about the different types of star ratings in the past, TEP members recommended against combining the Quality of Patient Care and Patient Survey star ratings. Instead, TEP agreed, there should be a focus on clarifying the difference between the two types of ratings to consumers.

Mazza, however, has complicated feelings on the matter.

“I have mixed reviews on that, because i think it is hard for the consumer as well as the agency to understand data collection periods between the two, and they have different methodologies,” Mazza said. “I do think adding clarity to the definitions is very much needed.”

The functionality of the Home Health Compare website should also be improved, the TEP said. To start, Home Health Compare should enable the comparison of more than three agencies at once, and enable consumers to search and sort agencies based on star ratings and categories of interest.

Overall, the TEP’s recommendations accurately reflect the desires of home health agencies across the country, Berman said.

“I feel like the TEP really did a good job in identifying a lot of the issues that really echo what many of the home health agencies feel,” Berman said. “I think it really represents the gamut well of what we would like to see.”

Written by Mary Kate Nelson

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