You’re trying to grow your census, but your referrals are stalling. You’ve improved care delivery, trained your staff, and responded to every complaint. Still, you’re not getting picked over the competition.
Many agency owners don’t realize this slowdown could be tied to their star ratings—or worse, the absence of them.
At The Home Health Consultant, we help agencies improve public-facing metrics like CAHPS responses and star ratings as part of our Administrative Compliance Program. After working with hundreds of agencies, we’ve seen firsthand how these ratings can impact referrals, reimbursements, and even inclusion on hospital discharge lists.
In this article, we’ll break down:
- Exactly what Medicare star ratings are
- If hospice agencies get star ratings
- How Medicare star ratings are calculated
- Tips to help you improve your star ratings
After reading, you’ll be able to assess how your company stacks up, so you can start standing out for all the right reasons.
What Are Medicare Star Ratings for Home Health Agencies?
Star ratings are public scores that reflect your agency’s clinical performance.
They come from CMS (Centers for Medicare & Medicaid Services) and are published on Care Compare. Think of star ratings as a summary report card for the public. Patients, families, and referral sources use them to compare your agency against others.
Home health agencies receive two types of star ratings:
- Quality of Patient Care Rating – Based on OASIS outcomes and claims data.
- Patient Survey Rating (HHCAHPS) – Based on patient satisfaction surveys from third-party vendors.
Each is scored between 1 and 5 stars, with 5 being the highest.
Do Hospice Agencies Get Medicare Star Ratings Too?
No, hospice agencies do not get Medicare star ratings yet. While hospice providers are subject to public reporting via Medicare Compare, they do not currently receive CMS-issued star ratings.
Instead, hospices are scored using quality indicators like:
- Pain and symptom management
- Patient/family experience (CAHPS® Hospice Survey)
- Timeliness of care
However, it’s expected that more formal scoring, possibly including star ratings, could emerge for hospice under ongoing CMS reforms. To read about the newest update coming to hospice agencies, check out our article on how HOPE is replacing HIS below.
What Data Is Used to Determine Star Ratings?
For home health, star ratings are based on two main data sources:
- OASIS Outcome Measures (OBQI)
These include but are not limited to:- Improvement in walking or moving around
- Improvement in transferring
- Improvement in bathing
- Medication management
- Avoidance of hospitalizations
- HHCAHPS Patient Surveys
These include but are not limited to:- Communication with providers
- Timeliness of care
- Overall care satisfaction
- Willingness to recommend your agency
Star ratings compare your agency’s data to both state and national averages. To learn more about how star ratings are calculated, check out this fact sheet from CMS answering most commonly asked questions.
Why Don’t Some Agencies Have Star Ratings?
There are two common reasons agencies may not have star ratings yet:
- Low census or volume: If you haven’t submitted enough qualifying OASIS assessments, CMS won’t generate a star rating. The minimum is typically 20 completed episodes over a 12-month period.
- New agency status: CMS waits up to 6-8 months before enough data accumulates to calculate your scores.
So if you don’t see any stars, it’s likely your agency is too new or too small.
Are Star Ratings Kept Up to Date?
While data reporting has strict deadlines, it takes a minute for your star rating to catch up. Star ratings reflect performance from 6–12 months ago.
This is because OBQI reports (which fuel the quality ratings) run several quarters behind. So if you improved something last month, it won’t show up in your star rating yet.
How Can Agencies Use Star Ratings in Marketing?
Once you hit 4 stars or more, your star rating becomes a valuable marketing tool.
Here’s how you can use your rating to promote your agency:
- On your website and brochures: Include a callout like “Rated 4.5 Stars on Medicare’s Care Compare.”
- In physician outreach: Highlight performance-based outcomes like “We outperform state and national averages in medication teaching.” This makes doctors more likely to refer patients to you.
- With discharge planners: Agencies with higher star ratings are more likely to be chosen from hospital referral lists.
CMS allows public use of star ratings, just make sure to represent them accurately.
Can Star Ratings Affect Referrals and Reimbursement?
Yes, star ratings can affect referrals and reimbursement both indirectly and directly.
Indirectly: Referral sources may choose agencies with higher star ratings when no other differentiator exists. Since it is illegal for Medicare-certified agencies to offer incentives or exclusive services, public quality scores do the talking.
Directly: Star ratings influence your Value-Based Purchasing (VBP) score, which determines how much reimbursement you keep (or lose). Higher star ratings = better VBP = better revenue. To read more about Value Based Purchasing and how it can affect your agency’s bottom line, check out the article below.
What Are the Home Health Star Ratings Averages for 2024?
Understanding national averages helps you benchmark your agency's performance.
As of October 2024, the distribution of Quality of Patient Care Star Ratings among Medicare-certified home health agencies is as follows:
- 5 stars: 3.77%
- 4.5 stars: 9.3%
- 4 stars: 10.22%
- 3.5 stars: 10.81%
- 3 stars: 10.02%
- 2.5 stars: 8.28%
- 2 stars: 6.48%
- 1.5 stars: 5.1%
- 1 star: 1.27%
This distribution indicates that most agencies fall between 3 and 4 stars, with a smaller percentage achieving the highest ratings. Minimum goals for your agency should be to land at that national average (between 3 and 4 stars), if you’re not there already.
If you're curious to see what star ratings actually look like, CMS provides an example of Star Ratings Report Sheet on their website.
How Can You Improve Your Star Ratings?
Improvement takes consistency and strategy. Start with these:
- Audit your OASIS documentation: Ensure accuracy in capturing functional improvements. If you’re not documenting improvements correctly, they won’t be reflected in your ratings.
- Monitor OBQI trends: Use quarterly reports and programs to spot issues early. Then work on improvements with routine QAPI programs.
- Partner with compliance experts: Programs like ours help monitor and improve star-related metrics. With a compliance framework in place to help you implement and hold your team accountable, improving your scores can become much easier.
And remember, star ratings aren’t just about what you do. They’re about what you prove through documentation and outcomes.
Want help improving your ratings before they affect your revenue? Our Administrative Compliance Program helps agencies raise their scores, avoid deficiencies, and get selected more often.
If you’re not sure if your agency needs a consultant to help raise your scores, we have an article to help with that as well. Click below to learn the most common times agencies like yours hire consultants, and figure out what’s best for you.
If you know you want a helping hand to improve your scores, schedule a call with our team today to learn how we can help your agency.
*This article was written in consultation with Mariam Treystman.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
