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Improving Home Health Star Ratings: Part One

Most home health organizations have seen their census return to pre-pandemic levels, and in some cases, have increased and grown their operations because of greater appreciation for in-home care due to COVID-19.

As a new “normal” evolves, the focus of the Centers for Medicare and Medicaid Services (CMS) remains on advancing value-anchored payment models and patient-centered care, with an emphasis on home health star ratings.

Why Are Home Health Star Ratings So Important?

The home health star rating system was introduced in 2015 to the Home Health Compare website with the Quality of Patient Care five-star score, and was followed by the Patient Survey five-star score in 2016.

In addition to other detailed information, the star ratings summarize key performance measures in an easy-to-understand format, improving the ability of consumers to compare and choose high-quality home healthcare providers.

This data is updated by CMS quarterly and is also utilized by common referral sources, including hospices, hospitals and insurers, to identify potential home health organization partners. Since four- or five-star home health organizations are typically sought out as potential partners, improving scores is vital for long-term home health success.

Identifying the Star Ratings

There are two kinds of home health star ratings:

  1. Patient Survey Star Ratings – Based on Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) composite data:
    • Care of patients
    • Communication between organizations and patients
    • Specific care issues
    • Overall rating of care provided by the organization
    • Would you recommend this organization
  2. Quality of Patient Care Star Ratings – Based on Outcome and Assessment Information Set (OASIS) data and claim measures.

In order to increase both home health star ratings, you must improve Home Health CAHPS results and the accuracy of OASIS documentation.

How to Improve Home Health CAHPS Survey Results

The Home Health CAHPS survey assesses the overall experience of patients with home health organizations from admission.

The survey is comprised of 32 questions about the patient’s interactions with the home health organization during admission and throughout their care. The responses are grouped into three composite measures, two of the questions are reported on the CMS Care Compare website and four are utilized for reporting Patient Survey Star Ratings.

A great way to educate staff on elements of the HHCAHPS survey is to review a question at each staff meeting and discuss ways to improve processes to continually improve patient care.

Axxess has provided an HHCAHPS question by question review, with tips on improvement for all questions in the survey.

Quick Tips to Improve HHCAHPS Survey Results

  • Ensure all staff review and understand the HHCAHPS survey questions and the answer options. Once topics are identified, the staff can focus on improving these areas.
  • Since patients are selected at random, not all will be asked to complete a survey. However, it is important to educate all patients on the survey and encourage them to complete it if contacted by your survey vendor.
    • The guidance from CMS allows staff to highlight that a survey will be administered during the Start of Care and Resumption of Care, and patients may be surveyed by your current survey vendor.
    • However, you may not share a copy of the HHCAHPS survey with patients, tell the patient how to answer or demand the patient provides a positive review.

The changes implemented should become part of the organization’s standard operating policies and procedures. They should also be monitored as part of Quality Assurance Performance Improvement (QAPI) planning on at least a monthly basis, while checking the CMS Care Compare public reporting at least quarterly.

Axxess Home Health, a cloud-based home health software, provides valuable Patient-Driven Groupings (PDGM) tools built in for accurate OASIS submission, and is an approved HHCAHPS vendor that handles all CAHPS reporting for home health organizations.


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