What’s not to love about CMS’ star rating system for home health? Plenty.
First, this July, CMS will need to synchronize Home Health Compare scores with the star rating system, resulting in a permanent delay of published scores by an additional quarter. Hospitalization data, the # 1 focus for home health and hospitals, will be a whopping nine months old. On the eve of value-based purchasing, when quality performance has never been more critical, availability of the public data used to evaluate care takes a step backward. This is progress?
The star rating is not viewed favorably by many home health agencies for a variety of reasons, including some of the included measures - pneumococcal vaccine, for instance. Oftentimes, elderly patients have no idea if they’ve received this vaccine. Also, an agency’s ability to stabilize patients is not taken into consideration in the rating system, though it’s often the desired and only outcome for certain patients.
CMS announced at last week’s Special Open Door Forum (SODF), that it has revised the star ratings to include half star increments. Despite this, due to the egregious way in which the overall rating will be calculated, a full 64% of all agency ratings are expected to fall within 2.5 to 3.5 stars.
If an agency’s score on an individual measure is not statistically different enough from the median, it will be adjusted up if it is under 2.5, and down if it is over 3 by one half star. This means, an agency in the top decile for a measure (possibly with a perfect score) may only receive 4.5 stars instead of 5 for the measure due to the adjustment.
The objective of the star rating is to help consumers choose high quality providers, but CMS has its work cut out for it, as they’ll have to educate consumers on how an “average” score might actually equate to high quality care. The system is confusing and misleading. Star ratings are seen everywhere these days, and never does a 3-4 star rating signify “the best”, so how will consumers be expected to use this system in a meaningful way?
Typically, I use this last paragraph of the blog to offer up helpful suggestions, but there really aren’t any for the star rating. Maintaining high quality care is paramount for any number of reasons, but unfortunately that won’t guarantee you five stars under this new rating system. So Keep Calm and Carry On.