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Home Health Performance Rankings Limitations and Considerations

We computed home health care rankings using publicly reported data downloaded from the CMS Medicare website (www.medicare.gov/Download/DownloadDB.asp - last accessed 1/30/2017). This data set contains agency-specific, risk-adjusted, performance on 16 quality measures1 and five patient experience of care measures2 for over 12,000 agencies nationwide.  Twenty-two quality measures and five experience of care 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.

For the quality measures there are three measures related to patients’ ability to manage daily activities, five measures related to managing and treating patients’ pain and other symptoms, five measures related to treating wounds and preventing pressure sores, eight measures related to preventing harm, and two measures related to preventing unplanned hospital care. For the HHCAHPS there are three composite measures and two global measures. The quality and patient experience of care measures reflect only a portion of the patient care experience. We advise interpreting this information cautiously and supplementing it with information from the ombudsman's office, the State survey agency, or other sources.


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Data Limitations

  • The home health quality measures reflect resident outcomes and therefore require rigorous risk adjustment. While the quality measures are risk-adjusted to account for the fact that some agencies treat sicker patients, underlying differences in patient conditions or in the types of care provided by the agencies may not be fully accounted for by risk adjustment strategies. The best achievable rates for these measures is not well understood at this time.

  • The quality measures presented on Home Health Compare come from information collected by Medicare and Medicaid-certified home health agencies. This information is called the Outcome and Assessment Information Set (OASIS). OASIS is a group of elements that represent core items of a comprehensive assessment for an adult home care patient. All of these data are reported by the home health agencies themselves and are not formally audited to ensure accuracy.

  • The OASIS data displayed on the website are updated quarterly and represent a rolling 12 months of data but have a two-three month data lag time. Recent improvements made by an agency will not be evident in the rankings.

  • Because of differences in the number of patients served by agencies the clinical conditions of the patients they care for, the number of patients used to compute reported performance rates varies by agency and measure. This impacts the precision with which performance can be ranked.

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Analytic Considerations

  • Performance on the measure “Percentage of patients who had to be admitted to the hospital” contributed half to each agency’s national ranking on the quality measures. The remaining quality measures were given equal weight in the analysis regardless of the eligible number of patients for each agency or of any assessment of the relative importance of the measure.
  • For the HHCAHPS all measures contribute equally to agencies’ national rankings.
  • While percentile scores, by definition, always range from 0-100, reported performance on a given measure may cluster very tightly.
  • A single composite performance score or ranking can mask either strong or weak performance in specific measures.

1The 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 patients had less pain when moving around.
  • How often patients’ breathing improved.
  • How often patients’ wounds improved or healed after an operation.
  • 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.

2The 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.