What are the Home Health Star Ratings Questions and Home Health Quality Measures?

What Makes Up The Star Ratings For Home Health Agencies?

One thing that is always difficult is to find inclusive, up to date information about OASIS assessments.  You can find a lot of information, but it isn't easy to find a succinct list of what you're looking for.  

At Home Care Answers, we try to stay up to date on all things Home Health, and try to be ahead of the curve so that we're a resource for our agency partners.  We don't like to think of our clients as clients.  We want to think as a long term partner.  We believe we owe it to our partners to be a resource so that we can help answer questions and give valuable guidance should questions arise.

Many Agencies have put almost all available resources to PDGM- and rightly so.  However, CMS is still gathering important information from OASIS assessments.  One thing that Home Health Agencies need to keep top of mind is the star rating.  5 Star Questions are still very important to agencies to make sure that patient outcomes are positive.  

CMS Star Rating Methodology

CMS looks at quality measures and updates them usually quarterly.  During the pandemic, Star Ratings have not been updated or really followed so that agencies can focus on other patient care.  

The CMS Star Rating questions and quality measures are really looking at certain OASIS questions and comparing the results at the beginning of the episode or Start of Care to the end of episode at discharge.  Did the patient improve?  Did the patient decline?  These metrics are then used to grade the quality outcomes of agencies.  CMS uses a system of 1-5 with half steps to essentially grade agencies on their quality of care.  Did the patient improve using key questions on the OASIS?  

You can use the Home Health Compare link provided here to check star ratings.

What are the Star Rating Questions

You may ask yourself, what are the 5 Star Questions anyway and what do they do?  The 5 Star Questions are OASIS questions that measure patient improvement and outcomes based on OASIS answers from the Start of Care to Discharge OASIS.  Here is a list of the OASIS Questions that make up the 5 Star Ratings.

M0102 - Date of Physician-ordered Start of Care (Resumption of Care): If the physician indicated a specific start of care (resumption of care) date when the patient was referred for home health services, record the date specified.

M0104 - Date of Referral: Indicate the date that the written or verbal referral for initiation or resumption of care was received by the HHA.

M1242 - Frequency of Pain Interfering with patient's activity or movement.

M1400 - When is the patient dyspneic or noticeably Short of Breath?

M1830 - Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair).

M1850 - Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast.

M1860 - Ambulation/Locomotion: Current ability to walk safely, once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces.

GG0100 (ALL)

GG0110 (ALL)

GG0130 (ALL)

GG0170 (ALL)

J1800 - Any Falls Since SOC/ROC, whichever is more recent.

J1900 - Number of Falls Since SOC/ROC, whichever is more recent.

Tracking 5 Star Questions

Home Care Answers has built a platform that tracks every suggested change to any OASIS question.  We can do this on multiple levels- corporate entity, branch, and all the way down to the clinician level.  We can tell you which questions are questions that are opportunities for improvement in training, QAPI, and even clinical performance.  For example, here is what we show in our administrative dashboard for an agency for the Star Rating Questions.  We help agencies track the error rates so that they can understand where to train.  

5 Star Questions (Sample of Top Suggested Changes)

M1850 Transferring7438 / 20744 Changed 35.860%

M1860 Ambulation7196 / 20744 Changed 34.690%

M1400 Dyspneic6050 / 20744 Changed 29.170%

M1830 Bathing5830 / 20744 Changed 28.100%

M1242 Frequency of Pain 4972 / 20744 Changed 23.970%

GG0130C13479 / 20744 Changed 16.770%

GG0130G12826 / 20744 Changed 13.620%

GG0130F12443 / 20744 Changed 11.780%

GG0130H12396 / 20744 Changed 11.550%

GG0170F12290 / 20744 Changed 11.040%

GG0170I12229 / 20744 Changed 10.750%

GG0170E12138 / 20744 Changed 10.310%

GG0170D12046 / 20744 Changed 9.860%

GG0130E11722 / 20744 Changed 8.300%

GG0130A11721 / 20744 Changed 8.300%

Want to see more?  You can click on the report and then track by clinician.  You see that the agency is suggesting changes to M1850 31% of the time.  But the clinician below shows that we're suggesting changes to M1850 71.257% of the time.  This says that this clinician likely doesn't understand hat the question is actually asking.  

Top of Form

Team or Clinician

Start

End

Search

Bottom of Form

Totals

You can look at this report for any time configuration you desire.  

This has been very helpful for our agency partners to understand where pain ports, knowledge gaps, or misunderstandings may lie within the agency.  Many scrubbers will show some of this information, but the scrubbers only see when the data is done and complete, and that may not be what the clinician initially answered.  We show both.  

How do I increase my star ratings in home health? 

Many agencies wonder and feel helpless on how to improve their star ratings.  Home Care Answers can help with that.  One of the largest reasons that agencies do not have higher star ratings is because the OASIS at the Start of Care was not correct.  If the OASIS at the Start of Care was not correct, then it will be very difficult for the agency to show improvement on those certain questions. It's like comparing apples and oranges.  

Often, patients do show improvement under the great are of home health agencies.  However, the agencies simply aren't getting credit for it because OASIS wasn't correct at the beginning.  If it's not correct at the beginning, then the likelihood of OASIS being correct at discharge is not high.  

Home Care Answers can help agencies by making sure OASIS is correct at the beginning of the episode.  Agencies that really understand how we can help is allowing us to review the discharge OASIS also.  Then we're using the same measuring stick to compare and audit the OASIS.  This way, agencies get credit for the good work they are doing to help patients.  

Star Rating and Reimbursement Correlation

One of the things that we often find is that reimbursement and star ratings are usually correlated.  Agencies with lower star ratings are usually not maximizing reimbursement through OASIS and coding.  Home Care Answers wants to help agencies succeed by ensuring OASIS is correct and diagnosis coding is accurate.  When things are correct and accurate, revenue follows, star ratings follow, compliance follows, and patient outcomes follow as well.   Here is a refresher on OASIS documentation for dummies we did in a previous blog.  Click here to read it.  

We love to help agencies improve in Star Ratings.   That shows agencies care about the right things.