The process of improving your organization’s home health star ratings can be a daunting task to take on. It can be especially difficult if your organization accepts multiple insurance payers, since the outcomes and process measures which form patient star ratings are derived from the Outcome and Assessment Information Set (OASIS) and claims data from patients with Medicare only.
However, it is not impossible to achieve a higher star rating, even if you have multiple insurance payers.
Where to Focus to Improve Your Star Rating
You can use the following tips to enhance the patient experience and decrease clinician pain points, improving your star rating.
1. Get to Know Your Payer
It’s important to manage both your payer and client expectations. Any misunderstandings may lead to negative reviews from patients, regardless of their payer source.
2. Increase Your Number of Medicare Patients
Increasing the payer mix to include more Medicare patients can dilute negative outcomes and increase positive ones. A higher percentage of Medicare clients will ensure that star ratings are more reflective of the organization’s quality initiatives and outcomes. When you have low levels of Medicare clients, then every poor outcome has a bigger impact on the overall star rating.
3. Review New Payers and Insurances Upfront
Payers with severe limitations regarding visits may not be ideal for your organization or clinicians. The restrictions of certain payers can affect the experience of your clinicians. In fact, clinicians may feel that their judgement, skills and knowledge are not being recognized. Payers with strict limitations may set a negative tone for care discussions of all patients and clinicians may feel that their ability to assist the client is negatively impacted by financial considerations.
If a payer only provides a limited number of visits per discipline, ensure that your team makes the most of each visit. Taking an extra five or 10 minutes to check in with the patient and family, and making sure their needs are being met, can have a large impact on referral sources who will be completing their quality checks.
4. Educate Health Insurance Plan Members on All Eligible Services (Including Preventative Health)
Providing health education is an important part of any treatment plan regardless of payment source. Patients should be informed of all available services; while they may not qualify for care in one category, they may under a different benefit.
5. Take Advantage of Technology
Use the technology available to you, including electronic medical records and remote telemonitoring. This method of improved documentation supports measured outcomes. Using technology to build a robust plan of care can also produce good outcomes.
6. Communicate, Communicate, Communicate
Communication is key. Your organization should communicate often with referral sources, payers, patients and their families. Good customer service supports better compliance, treatment plan buy-in and outcomes for all patients, not just those with Medicare only.
More than anything, star ratings reflect the level of care patients received. The more positive your patient feels about their at-home care, the more positive the outcome will be.