What Those Medicare Quality Ratings Actually Mean

When you're trying to choose a home health agency, Medicare's star ratings seem like a godsend. Finally, an objective way to compare! Just pick the 5-star agencies, right?

It's not quite that simple. The ratings are useful, but understanding what they actually measure helps you use them correctly.

Two Different Ratings

Medicare publishes two separate star ratings for home health agencies:

Quality of Patient Care measures outcomes. How often do patients improve in walking? In getting in and out of bed? Are emergency room visits and hospitalizations happening at lower-than-average rates?

Patient Survey measures satisfaction. Would patients recommend this agency? Did staff communicate well? Were patients treated with courtesy and respect?

These measure different things. An agency could be clinically excellent but have poor communication, leading to high quality scores but low patient satisfaction. Or vice versa.

Look at both ratings when you're comparing agencies.

What the Quality Rating Measures

The quality rating is based on several specific outcomes:

Improvement measures track whether patients get better in specific areas - walking, getting in and out of bed, bathing, breathing. Higher improvement rates are better.

Potentially avoidable events track things like unplanned hospitalizations and ER visits. Lower rates are better - it suggests the agency is managing patients well enough to keep them out of the hospital.

Timely initiation of care measures whether home health started within 2 days of the referral. Faster is better.

These are objective measures based on data the agency reports to Medicare.

What the Patient Survey Measures

The patient satisfaction survey asks former patients (or their family members) questions like:

Would you recommend this agency to friends and family? How often did staff treat you with courtesy and respect? How often did staff communicate well? Did you get the care you needed?

This is more subjective than the quality measures, but it captures something important: what's it actually like to receive care from this agency?

What the Ratings Don't Tell You

Star ratings have significant limitations:

They don't measure specific conditions. An agency might be great with post-surgical patients but mediocre with chronic disease management. The ratings don't break this down.

They don't capture personality and fit. Some people prefer a very professional, clinical style. Others want warmth and chattiness. Ratings can't tell you which kind of staff an agency tends to hire.

They're based on past data. An agency that had a rough year might have since improved. An agency that was great might have had recent turnover that degraded quality.

Small agencies may not have enough data. If an agency serves a small number of patients, their ratings might be marked "not available" or might swing wildly based on a handful of cases.

How to Actually Use the Ratings

Here's a reasonable approach:

Use ratings to eliminate poor performers. If an agency has 2 stars or lower on both measures, that's a red flag worth taking seriously.

Don't assume 5 stars means perfect. A 5-star agency that doesn't serve your area, doesn't have availability, or doesn't communicate well with you isn't worth choosing just for the stars.

Compare agencies on the measures that matter to you. If you're most worried about ending up back in the hospital, focus on the hospitalization and ER rates. If you're worried about improving function, look at the improvement measures.

Supplement with other research. Ask your doctor which agencies they've had good experiences with. Talk to people who've used local agencies. Call the agencies and see how responsive and helpful they are.

Where to Find the Ratings

Go to Medicare's Care Compare website: medicare.gov/care-compare

Select "Home Health Services," enter your zip code, and you'll get a list of agencies in your area with their ratings. You can dig into the specific measures for each agency.

A Few Other Things on Care Compare

Beyond star ratings, the Care Compare website shows:

Services offered - not all agencies provide all types of care (skilled nursing, PT, OT, speech therapy, medical social work, home health aide).

Contact information - so you can call and ask questions directly.

Ownership type - whether it's a for-profit, non-profit, government-owned, etc.

The Real Bottom Line

Quality ratings are one data point, not the final answer.

A 4-star agency that can start care tomorrow, has experience with your specific condition, and communicates clearly on the phone might be a better choice than a 5-star agency with a waiting list that seems disorganized when you call.

Use the ratings as a starting point, not a conclusion. Then talk to the agencies, ask questions, and trust your judgment about which one seems like the right fit.