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CMS Star Rating System: Are you a 5-Star Provider?

On July 16, 2015, CMS announced that it would adopt a quality of patient care star rating system. Similar to what is used on online retail sites and restaurant review websites, the star rating system will give consumers a quick and easy way to compare provider quality. The star ratings are aimed to help summarize the vast information already available on the Home Health Compare (HHC) website so that consumers can make both quick and well-reasoned decisions when it comes to choosing a home health care provider. If you are a Medicare-certified HHA that has 20 complete quality episodes for data to be presented on HHC, then you are potentially eligible to receive a Quality of Patient Care Star Rating.

Currently, the HHC website displays a total of 29 process, outcome and patient experience of care quality measures, however the Quality of Patient Care Star Rating includes 9 of these measures including:

  1. Timely Initiation of Care
  2. Drug Education on all Medications Provided to Patient/Caregiver
  3. Influenza Immunization Received for Current Flu Season
  4. Improvement in Ambulation
  5. Improvement in Bed Transferring
  6. Improvement in Bathing
  7. Improvement in Pain Interfering with Activity
  8. Improvement in Shortness of Breath
  9. Acute Care Hospitalization

The major debate going on now is whether CMS’s star ratings will actually improve HHA quality. While it does give agencies a better indication as to what areas they need to improve upon, it does seem to oversimplify vast data into mere infographics. Some hospitals have even spoken out against using this star based rating system because it belittles the amount of work they do to take care of a patient into just symbols. Only time well tell if these star ratings will actually help improve the quality of care of providers.

5-Star Quality Rating System for Nursing Homes

Even nursing facilities have adopted a star-based rating to system that helps consumers determine which provider is better suited for their needs. The Nursing Home Compare Website gives each nursing home a star rating between 1 to 5, with 5 stars being nursing homes that provide exceptional quality of nursing and care and 1 star nursing homes that present lower than average quality of care. Apart from the overall 5-star rating for the agency as a whole, there are separate ratings for each of the following sources of information:

  • Health Inspections – These can be conducted either due to standard surveys or customer complaints. Trained surveyors will go onsite and check whether the nursing facility adheres to all minimum quality requirements stipulated by Medicare and Medicaid.
  • Staffing – This rating gives you the number of hours of care provided on average to each resident by the nursing staff each day.
  • Quality Measures – This rating contains information on 11 different physical and clinical measures for nursing residents. It shows how well the nursing home cares for it’s resident’s physical and clinical needs.

So remember to always check out either Home Health Compare to find out a provider’s star rating.

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