Dueling Star Ratings May Confuse Some Home Health Patients | California Healthline

Dueling Star Ratings May Confuse Some Home Health Patients | California Healthline

Patients looking for home health care services will be impressed if they check out the federal government’s ratings of AccentCare. Two of the company’s home health agencies in California — in San Diego and Newport Beach and Rancho Cordova — each earned 4.5 or 4 stars, nearly the top quality score, primarily based on Medicare’s assessment of how often patients got better.

But further research may lead to confusion. Medicare also posts stars to convey how patients rate agencies after their care is over. There, these same three agencies earned two stars.

Such contradictory results between how patients view home health agencies and how the government rates them are hardly unusual. One in five agencies had clinical and patient ratings that differed by two stars or more, a Kaiser Health News analysis of government records shows.

In California, for instance, agencies were three times as likely to receive five stars for their patient reviews as they were for their clinical quality. Skilled home health services, where Medicare sends nurses, aides and physical and occupational therapists to people’s houses, are becoming more important amid pressures to keep homebound patients from going to the hospital. To help doctors and patients select among more than 12,000 agencies, Medicare last year published star ratings for clinical quality on its Home Health Compare website, and in January it added star ratings to reflect the views of patients.

Medicare was liberal in giving top marks based on patients’ opinion scores, awarding four or five stars to 74 percent of agencies it rated. Of those, 2,152 agencies got five stars.

Apparently Medicare is giving more attention to the "Patient experience". 

But in encapsulating clinical quality measures, Medicare used a different formula that ensured three-star ratings would be most common. Only 27 percent of agencies received four or five stars. Just 286 agencies received the maximum five stars.In a statement, the Centers for Medicare & Medicaid Service said the different star ratings should not be confusing. “CMS stresses that website users should look at all of the different types of measures available for a given provider type, including for home health care agencies,” the statement said. “By providing both clinically based and survey-based measures, CMS hopes to make available to the public a range of perspectives and information that consumers can evaluate to help inform their decision about an agency.”

As the number of quality metrics has proliferated, star ratings follow other Medicare efforts to distill sometimes complex quality assessments into a consumer-friendly format. Medicare also assigns stars for dialysis center quality, hospital patient experience and several aspects of nursing home care.

“We’re really talking about very different sets of metrics,” said Teresa Lee, director of the Alliance for Home Health Quality and Innovation, a nonprofit research group. “It’s unfortunate, but maybe it’s the truth that patient experience and clinical quality of care do not go hand in hand.”

Adding to the potential confusion, 41 percent of the star ratings summing up patient views are not reliable — by the government’s own admission — because fewer than 100 surveys were returned, records show. Home Health Compare warns consumers in footnotes to use the scores “with caution as the number of surveys may be too low to accurately tell how an agency is doing.” Medicare did not assign stars for agencies if fewer than 40 surveys were returned.

“It is important to point out that our patient population has an average age of 86 and often relies on family members, powers of attorney and/or guardians to complete” the survey, she said.

Some elder care experts have broader reasons to question the ratings.

While there is some confusion and questions about the validity of these surveys and the more objective Medicare quality measures,  patients' families now have somewhere to screen  possible caregiving agencies for their loved ones.