by James C. Sherlock
I have been using Medicare Care Compare ratings in my research and writing for 15 years.
Regular readers are familiar with my work on hospitals. I published in this space an extensive series on Virginia nursing homes. For quality ratings and consumer survey data, there is absolutely no substitute for Medicare Care Compare.
This article is about home health services.
There are other rating “services.” Ignore them. None has the timeliness or volume of objective data available on Medicare Care Compare.
The Centers for Medicare & Medicaid Services (CMS) has built the Care Compare website as a decision aid. I find it to be the easy-to-access, convenient and up-to-date official source of information about provider quality that CMS intends. It gets better all the time.
This website displays for Medicare-certified home health agencies both data compared to national and state norms and star ratings for:
- clinical measures compiled from the Outcome and Assessment Information Set (OASIS) Prospective Payment System (PPS); and
- the results from the Home Health Consumer Assessment of Healthcare Providers & Systems (HHCAHPS) surveys.
Results are based on data from the last four quarters and are updated each quarter.
CMS assigns weights to each measure, calculates the results, adjusts for patient mix, and awards quality and consumer stars on a Bell curve. Across the country, most agencies fall in the middle with 3 or 3½ stars.
It represents a very tough cut. Which is what makes it so useful.
- You will find 240 Medicare-certified home health agencies in Virginia;
- Only five of the 240 have five-star quality ratings;
- Eleven have five-star patient survey ratings, and one of those has a cautionary note about small sample size;
- Only two have 5-star ratings in both quality and patient surveys. Those are Twin County Regional Home Health in Galax and Commonwealth Healthcare at Home in Danville;
- Only 141 have quality ratings of 3 stars or above;
- Nine have quality ratings of 1 or 1.5;
- Forty seven have insufficient data for a star rating in either category.
Check next quarter and those ratings may have changed.
CMS has made that system nearly impossible to game. And the penalties for getting caught doing so are too much to bear.
I will walk through an example to demonstrate how to use Medicare Care Compare to find the best home health care near your zip code.
Background. Code of Virginia § 32.1-162.9:1. requires home health agencies to screen employees for barrier crimes with a criminal records check and to conduct drug testing.
Since January of 2020, the Quality of Patient Care (QoPC) Star Rating for home health is based on OASIS Prospective Payment System data assessments and Medicare claims data. All home health agencies that take Medicare patients have been using OASIS since July of 2019.
Consumer Survey Star Ratings are based on the Home Health Consumer Assessment of Healthcare Providers & Systems (HHCAHPS) surveys. Those surveys are focused on how patients experienced or perceived key aspects of their care, not how satisfied they were with it. These data have been collected since 2010 and publicly reported since 2012.
Many QoPC and CAHPS measures are statistically adjusted to correct for differences in the mix of patients across providers and the use of different survey modes.
These two data sources in turn help CMS adjust payment models so that instead of paying only for the number of services provided, it also pays for providing high quality services.
So they are not just for you, but they can help you a lot.
Services offered. For each Medicare-certified home health agency, Medicare Care Compare reports at a mouse click yes or no on the availability of the following:
- Nursing care
- Physical therapy
- Occupational therapy
- Speech therapy
- Medical social services
- Home health aide
Quality.
CMS captures from these home health providers seventeen categories of quality-related data: four in managing daily activities; two in treating symptoms; six in preventing harm; four in preventing unplanned hospital care; and one in payment and value of care. These are based on the agency’s patient assessments and Medicare claims.
You can click on and open each of the agencies with a star rating in quality and examine each of the seven measured categories.
Consumer survey. There are 25 “core questions” and 9 “about you” questions on HHCAHPS. Those, too, are updated as required.
The questions are grouped into three survey “composites” or groupings of like topics for the purpose of public reporting. The three composites that are publicly reported are “Care of Patients,” “Communications Between Providers and Patients,” and “Specific Care Issues.”
They also report the results of two global or overall measures (questions) called “Overall Rating of the Home Health Agency” and “Would You Recommend this Agency to Family and Friends.”
How to use it. The list of agencies near my own 23451 zip code who are certified by Medicare can be found here.
That link brings up a list of 26 nearby agencies which I have presorted by quality star rating. Some on that list have star ratings. Some do not.
Fni Healthcare is a 5-star-rated company in care quality, the only one on this list. It is headquartered in Virginia Beach and has an office here. The overall organization is awarded five stars and the local office 4.5 for quality. Its performance on managing daily activities is off the charts perfect and treating symptoms and preventing harm almost so. Medicare does not have enough survey responses to give it a patient rating.
Interim Healthcare may prove a good choice. Medicare awards it 4.5 stars for quality and 4.0 stars for patient survey ratings. Those combined make Interim an outlier on the upside. It exceeds both national and Virginia averages on each of the five categories of patient survey rating. Interim’s results on both treating symptoms and preventing harm are absolutely extraordinary.
Centerwell Home Health, Bon Secours Home Care and Westminster Canterbury at Home LLC each has 4-star ratings for both quality and patient survey results.
If I were doing the choosing, I would interview these five on the phone, starting with Fni and Interim, to see who could and would provide the help I sought. Staffing is tough, especially where standards are high. Which is what we are all seeking.
Hope this helps.
You probably do not need it today or tomorrow, but you or a family member or friend likely will someday.
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