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Many potential patients looking into home health care agencies in the state may wonder at the conflicting ratings: a three out of five stars from Medicare, and a five out of five from patient satisfaction surveys.

The conflict is inherent because the way the ratings are evaluated. Medicare’s clinical quality measurement takes into account observable factors, including how quickly the agency starts administering care and how many hospitalizations it has, according to a Kaiser Health News analysis of the data.

There are about 12,000 home health agencies in the country that send care workers, including nurses, aides, therapists, nutritionists and social services, to a patient’s home.

The patient surveys assessed the more qualitative aspects, like “how well health care workers explained to patients how to take care of themselves and whether they treated patients with gentleness, courtesy and respect,” according to the article.

To complicate the system further, about 40 percent of the patient ratings listed with a home health care agency are “not reliable” because not enough responses were returned to the agencies.

KHN reports that Medicare was very “liberal” in giving home health agencies four or five stars based on the opinion scores. About 74 percent of those agencies received top marks, while on the government’s scorecard, the system ensured that three stars would be the most common.

According to a Centers for Medicare and Medicaid Services (CMS) statement:

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. 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.

KHN’s analysis shows that one in five agencies has ratings that differ by two or more stars. Nineteen in Pennsylvania fall in this category, and all except one have higher patient ratings than government ones.

Two Pennsylvania agencies made it into KHN’stop-30 list for matching both 5-star government and patient ratings: Nason Hospital Home Health Agency in Roaring Spring, Blair County, and TriCounty Home Health and Hospice in Pottstown, Montgomery County.

Concerned about the quality of the ratings, some experts expressed doubts to NPR. They said that home health care can be limited to only once every two weeks, which would have no bearing on a patient’s day-to-day activities.

The poor ratings could also be because of regional differences. Some areas don’t have a lot of services or the staffing to make many home visits, so people who become sick have to go to the hospital.

Some agencies may even refuse service to particularly sick people or those with chronic illness who can be a “big burden” to them, according to KHN.

Finally, there is also the issue that patients may not comprehend the surveys they’re filling out.

“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, Kristin Puckett, a Brookdale Senior Living spokesperson told KHN.

Even then, patients may be too sick and in need of treatment to look exhaustively at the rankings before making a selection.

Reach Stephanie Roman at sroman@publicsource.org. Follow her on Twitter @ShogunSteph.

http://publicsource.org/from-the-source/issues-surround-home-health-rating-system#.Vs4ycObLkY0

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