Consumers seeking help meeting their health care or long term care needs face a confusing array of choices in care providers. How do they evaluate the quality of care that is available from various doctors, hospitals, nursing homes, Medicare plans, and home health agencies?
The federal government, through its Centers for Medicare and Medicaid Services (CMS), is trying to give consumers information that will allow them to navigate their many options and make better informed choices when selecting a health care facility or other provider.
CMS uses a five-star quality rating system to summarize Medicare beneficiaries’ experience with various plans and providers. Ratings posted on the CMS website at www.medicare.gov thus give beneficiaries some guidance in choosing from among plans and providers offering services in their area. CMS states that the “star ratings are an additional tool to support consumers’ health care decision-making.” Star ratings are currently publicly displayed by CMS on Nursing Home Compare, Physician Compare, Dialysis Facility Compare, the Medicare Advantage Plan Finder, Hospital Compare, and Home Health Compare.
On July 16th CMS issued its initial “Star Ratings” for Home Health Agencies. The ratings provide consumers in Pennsylvania and elsewhere with some gauge of how individual Home Health Agencies have performed in meeting various goals that are important to patients. In addition to summarizing Home Health Agency performance for consumers, the ratings are also intended to help the agencies identify areas for improvement.
Medicare certified Home Health Agencies are primarily engaged in providing skilled nursing services and other therapeutic services in your home. You must be under the care of a doctor and you must be getting services under a plan of care established and reviewed regularly by a doctor. Additional restrictions apply. For example, Medicare doesn’t pay for homemaker services or personal care.
All Home Health Agencies in Pennsylvania are licensed by the PA Department of Health. Medicare will only pay for services provided by agencies that are also approved by CMS.
The star rating summarizes each agency’s performance across 9 quality measures, including things like: Managing daily activities; Managing pain and treating symptoms; Treating wounds and preventing pressure sores (bed sores); Preventing harm; Preventing unplanned hospital care.
The rating range is 1 to 5 stars, with 5 stars being the highest rating. A rating of 4 or 5 stars means the agency performed better than most other agencies on selected measures. A rating of 1 or 2 stars means that the agency’s performance was below the average of other agencies on selected measures. Most agencies fall “in the middle” with a rating of 3 to 3½ stars.
CMS rated 286 Pennsylvania Home Health Agencies. 38% of the Commonwealth’s agencies received either 4 or 5 stars, 45% received 3 or 3.5 stars, and 18% received 2.5 stars or lower.
Star Ratings are available on the CMS website at http://www.medicare.gov/homehealthcompare/.
Getting the star rating and other information on a home health agency seems a bit confusing at first (at least to me). You need to enter your city and state or zip code and choose from the list of providers in your area. Then click “Add to Compare” on the chosen agency and scroll down and click on “Compare Now.” (Choosing more than one provider didn’t seem to work – at least for me. But choosing just one provider and then clicking “Compare Now” takes you to the information for that agency.) To get to the star rating click on the “Quality of Patient Care” tab and then scroll down. In some cases a rating is not currently available for a particular agency.
CMS also provides consumers with a checklist to use when comparing Home Health Agencies.