CMS Proposes Two Changes to Home Health Star Ratings Algorithm

One measure behind home health quality of patient care star ratings may be on its way out, but another is poised to take its place.

The Medicare Learning Network, an education and outreach arm of the Centers for Medicare & Medicaid Services (CMS), outlined two recommended changes to quality of patient care star rating methodology on Wednesday, both having to do with measures related to medication adherence.

Proposed changes include the removal of the OASIS-based “drug education on all medications provided to patient [and] caregiver” measure in calculating star ratings, along with the addition of a measure looking at improvement in management of oral medications, which is already reported on in Home Health Compare (HHC).


Removing the drug-education measure from star rating calculations has become necessary because of widespread improvement among home health agencies, effectively “topping out” the measure, according to the Medicare Learning Network. Currently, more than 53% of agencies have a score of 99% or higher for the drug-education measure, while more than 30% of agencies had a perfect score of 100%.

“These statistics show there is very little variation among agencies and also very little room for improvement,” a senior associate from Abt Associates said during a conference call on the recommended changes.

Essentially, the measure no longer carries any meaning, the associate said.


The addition of the “improvement in management of oral medications” measure in calculations would likely have no overall change on the average quality of patient care star rating of 3.27, according to the Medicare Learning Network

Apart from the newly proposed recommendations, the most recent change to star ratings calculations was the removal of the OASIS-based “influenza immunization received for current flu season” measure in April 2018.

There are currently more than 12,000 agencies in the home health setting, according to CMS. Star ratings are calculated based on a total of 23 quality measures on Home Health Compare: 14 that come from OASIS, four from claims information and five from the Home Health Care Consumer Assessment of Healthcare Providers and Systems survey (HHCAHPS). There are separate star ratings for quality of patient care and patient experience.

Other existing CMS star ratings programs include Nursing Home Compare, Physician Compare, Dialysis Facility Compare and Hospital Compare.

Home health stakeholders have from June 26 to July 26 to submit comments on the recommendations.

If accepted, they will go into effect during the April 2019 refresh of Home Health Compare.

Written by Robert Holly

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