Home Health & Hospice

Star (and half-star) ratings on the horizon for HHAs

Homecare Insider, February 16, 2015

CMS recently announced that the star rating methodology soon to augment Home Health Compare will include half-star increments—a departure from the agency’s previous iterations of the star system for the nursing home, physician, and dialysis Compare sites.

CMS revealed the news earlier this month during its second in a series of planned open door forums (ODF) on the upcoming addition of stars to Home Health Compare after a stakeholder suggested the half-star increments to more evenly distribute ratings.
 
Under CMS’ original plan, 52% of home health providers were projected to receive a rating of three stars out of a possible five. With half-star ratings in play, about 80% of HHAs are expected to fall between 2.5 and 4 stars, according to a PowerPoint presentation released in conjunction with the call.
 
The Home Health Compare site currently comprises a large database of provider quality information and is billed as a user-friendly tool to help consumers choose an appropriate HHA for their care needs.
 
However, CMS says the volume of information the site aggregates can be overwhelming to sift through when someone is faced with an urgent service need. In response to this challenge and directives from the Affordable Care Act to provide consumers with comprehensible summary information about providers, the agency announced its plans to add a five-star scoring scheme to the site last December—a decision met with increasing stakeholder concern.
 
Many participants on the most recent ODF expressed worries that, despite the flattened distribution of ratings offered in CMS’ most recent batch of proposals, the use of stars as a method of comparison rather than as a direct signifier of quality would still confuse consumers, misrepresent providers serving special populations, and ultimately jeopardize business.
 
To reduce the risk of these serious consequences, many ODF participants offered suggestions for conveying the particularities of the rating system to consumers. One caller asked CMS to include plain language on the Compare site explaining that the star ratings are different than those on Amazon, where there is no curve, and every product could hypothetically earn a top score.
 
Other callers were skeptical about the validity of some of the 10 measures chosen to comprise agencies' ratings and their equal weighting. For example, one caller questioned the appropriateness of considering hospitalization and pneumococcal vaccination equal indicators of quality, while multiple participants said these vaccinations shouldn’t be included in the calculation at all.
 
CMS will hold a final ODF sometime in the coming weeks to discuss any changes made to the prospective rating system based on follow-up stakeholder comments that were submitted to the agency by February 13.
 
The star ratings are scheduled to be released in July and updated quarterly. Providers will receive a preliminary report with their rating in March to give them time to address any disputed information with CMS, officials said.
 
To read CMS’ in-depth fact sheet on the prospective star system, click here.
 
To read HCPro’s previous coverage of the system, click here.