What Is The HHCAHPS Stars Ratings?

Is your home health agency delivering not just acceptable but high-quality care according to your patients?  Are your staff effectively communicating and connecting with your clients?  How do you compare to other home health agencies in your area?  But more importantly, do you know how many HHCAHPS Stars you have?  

In line with the Affordable Care Act’s goal for transparent and easily understandable public reporting of quality of care information, the Centers for Medicare and Medicaid Services (CMS) uses a 5-star scale rating with the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey.  The first national, standardized, and publicly reported home health care patient survey, the 34-item HHCAHPS survey was specifically designed to measure the experiences of people getting home health care from Medicare and Medicaid-certified HHAs.  It gathers feedback from current or recently discharged patients as well as their family or friends about their experience with an HHA.  The HHCAHPS survey is conducted by approved survey vendors either by mail only, telephone only, or a mix of mail survey with a telephone follow-up for non-respondents.  And to support internal customer service and quality-related efforts, the survey also allows HHAs to add their own customized questions after the core questions. 

HHAs with at least 40 completed HHCAHPS surveys over the publicly reported four-quarter period are qualified to receive HHCAHPS Star Ratings.  Those with fewer than 40 completed HHCAHPS surveys will not receive Star Ratings as they may not have sufficient statistical reliability to ensure true performance is measured; however, if they’re eligible to be reported during that time period, their individual HHCAHPS measure scores will still be publicly reported.  

The HHCAHPS Star Ratings at the Home Health Compare make it easier for consumers to compare home health agencies (HHA) and make informed decisions when choosing their home health care provider.  While the HHCAHPS Star Ratings do not impact an HHA’s Annual Payment Update (APU), the CMS believes that the HHCAHPS Star Ratings “will stimulate improvements in the quality of care delivered and provide incentives for HHAs to maintain or improve their own quality.”

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What Do The HHCAHPS Stars Ratings Measure?

The HHCAHPS Star Ratings are applied to each of the three publicly reported composite measures, from which specific questions from the survey are based, namely Care of Patients, Communication Between Providers and Patients, and Specific Care Issues. A Star Rating is also applied to the HHCAHPS global item, Overall Rating of Care.

On the other hand, an HHCAHPS Star Rating is not applied to the publicly reported Willingness to Recommend measure, as it mirrors the data in the Overall Rating of Care.  CMS has found the Overall Rating of Care measure to be more stable. 

To calculate the HHCAHPS Star Ratings, the responses to the survey items are first combined and converted to a 0-100 linear score and then adjusted for the effects of patient mix. To generate this adjustment, the CMS applies the patient-mix adjustment to quarterly HHCAHPS scores to account for certain patient subgroups that tend to respond more positively or negatively to the survey.  The four-quarter averages of HHCAHPS linear scores are then rounded to whole integers using standard rounding rules. 

Once the scores are linearized, adjusted and rounded, CMS assigns 1 to 5 stars for each HHCAHPS measure by applying statistical methods that analyze the relative distribution. The Star Rating for each of the four measures is then determined by the application of a clustering algorithm to the individual measure scores across HHAs. 

The four HHCAHPS Star Ratings are then combined as a simple average to form the HHCAHPS Survey Summary Star Rating. 

While more stars would mean a better home health care experience, a 1-star rating doesn’t necessarily translate to receiving poor home care from an HHA.  This may mean that HHAs that received 2 or more stars delivered a better home health care experience on this particular measure.  

An HHA that doesn’t have an HHCAHPS Survey Summary Star Rating means that they didn’t have enough surveys to allow star ratings to be meaningfully calculated, not that there is something wrong with the agency. 

Image: Antoni Shkraba Studio

How Cascade Strategies Can Help Your HHA With Your HHCAHPS Star Ratings

As we’ve touched on earlier, you can find your HHCAHPS Star Ratings at the Home Health Compare.  This user-friendly web tool allows one to select multiple HHAs at a time to compare the clinical quality of care provided and patient experiences at these agencies. 

Are you happy with your HHA’s HHCAHPS Star Ratings?  If you think your HHA can do a better job in getting more stars but need help formulating a gameplan, consider partnering with Cascade Strategies.  In addition to being an approved HHCAHPS survey vendor, Cascade Strategies brings over thirty years of high quality market research experience to the table.  For starters, we can help your HHA come up with the customized questions you can add after the core questions in your HHCAHPS survey.  Using the insights we can derive from the responses to these customized questions, we can help your HHA identify areas of improvement and figure out what steps you can take to achieve your goals.  To learn more about how we can help your HHA and your HHCAHPS Star Ratings, please contact us here.

Additional Reading:

How Researchers Are Helping Home Health Agencies with HHCAHPS Surveys

Featured Image: Tima Miroshnichenko

Top Image: Antoni Shkraba Studio

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