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We computed home health care rankings using publicly reported data downloaded from the Centers for Medicare & Medicaid Services (CMS) Medicare website - last accessed 1/27/2015). Rates are based on episodes of care occurring between July 1, 2013 and September 30, 2014.
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The Home Health Compare data set contains agency-specific, risk-adjusted, performance on 22 quality measures for over 12,000 agencies nationwide. The quality measures show how often home health agencies gave recommended care or treatments that research has shown gets the best results for patients (process of care measures), how often patients improved in certain important areas of care (improvement measures), and how often patients needed unplanned medical care or had to be admitted to the hospital (utilization measures).1 The data collection period for the process of care and improvement measures is 10/1/2013 - 9/30/2014; the data collection period for the utilization measures is 7/1/2013 - 6/30/2014. The process of care measures are not risk-adjusted; the improvement and utilization measures are risk-adjusted. All 22 quality measures were used in this analysis. To ensure reliability and stability of the measures reported, CMS suppresses reporting for agencies with small numbers of cases.
Agencies are ranked based on their average performance rate for the measures reported. To reflect the CMS emphasis on reducing hospital readmissions in this population, we gave equal weight to "How often home health patients had to be admitted to the hospital" and the average rate of the other measures included in the analysis. For the 8,924 agencies with a rate reported for the hospitalization measure and 12 or more additional measures, we computed national rankings of the weighted average performance. These rankings are presented as percentiles in the results tables.
The quality measures are:
- How often patients got better at walking or moving around.
- How often patients got better at getting in and out of bed.
- How often patients got better at bathing.
- How often the home health team checked patients for pain.
- How often the home health team treated their patients’ pain.
- How often patients had less pain when moving around.
- How often the home health team treated heart failure (weakening of the heart) patients’ symptoms.
- How often patients’ breathing improved.
- How often patients’ wounds improved or healed after an operation.
- How often the home health team checked patients for the risk of developing pressure sores (bed sores).
- How often the home health team included treatments to prevent pressure sores (bed sores) in the plan of care.
- How often the home health team took doctor-ordered action to prevent pressure sores (bed sores).
- How often the home health team began their patients’ care in a timely manner.
- How often the home health team taught patients (or their family caregivers) about their drugs.
- How often patients got better at taking their drugs correctly by mouth.
- How often the home health team checked patients’ risk of falling.
- How often the home health team checked patients for depression.
- How often the home health team determined whether patients received a flu shot for the current flu season.
- How often the home health team determined whether their patients received a pneumococcal vaccine (pneumonia shot).
- For patients with diabetes, how often the home health team got doctor’s orders, gave foot care, and taught patients about foot care.
- How often patients receiving home health care needed any urgent, unplanned care in the hospital emergency room – without being admitted to the hospital.
- How often home health patients had to be admitted to the hospital.
The HHCAHPS (Home Health Consumer of Healthcare Providers and Systems) is a national, standardized survey of patients’ (or their family’s or friend’s) experiences regarding the care they received from home health agencies. The survey asks a random sample of current or discharged patients 25 questions about their experiences with a home health agency. These questions are combined into three composite measures about specific aspects of the care received, and two global measures that reflect patients’ overall satisfaction with the care received.2,3 For each participating agency results on these five measures are publically reported on the Home Health Compare website. The data collection period for the HHCAHPS measures is 7/1/2013 - 6/30/2014.
The national rankings for the HHCAHPS are calculated by averaging each agency’s scores on the five measures. The agencies are then ranked on their average score and then the ranks are converted to percentiles.
The rankings displayed on this web site are presented as percentiles. A percentile is not a success rate and is not equivalent to the performance measure rates. Percentiles are values that divide a set of observations into 100 equal parts. The percentile rank is the percentage of values in a distribution that a specific value is greater than or equal to. For example, if an agency receives a rate of 60% on the measure “How often the home health team checked patients for pain improvement” and that rate was greater than or equal to the rates of 75% of all the other agencies then that rate would place the agency in the 75th percentile for that measure. A ranking in the 100th percentile does not mean that agencies in that percentile achieved perfect rates on all their measures; it indicates that their rates were better than all other agencies except for those who are also in the 100th percentile. Similarly, an agency with a rank in the 50th percentile did not achieve an average of 50% on their performance measures. They performed better than 50% of all the agencies in the country.
The HHCAHPS measures are:
- Percentage of patients who reported that their home health team gave care in a professional way.
- Percentage of patients who reported that their home health team communicated well with them.
- Percentage of patients who reported that their home health team discussed medicines, pain, and home safety with them.
- Percentage of patients who gave their home health agency a rate of 9 or 10 on a scale from 0 (lowest) to 10 (highest).
- Percentage of patients who reported YES, they would definitely recommend the home health agency to friends and family.
For more details on the HHCAHPS go to: http://www.medicare.gov/HomeHealthCompare/Data/HHCAHPS-Overview.html
Disclaimer: These rankings are based on data from CMS's Home Health Compare. HealthInsight used the data to calculate the statistics that are presented here. The analysis, and the display of the resulting rankings, were not paid for by CMS contract funds and do not reflect CMS policy.