REVEALING WITHIN-AGENCY VARIATION IN MEDICARE HOME HEALTH QUALITY RATINGS

Sep 28, 2026

Uploaded by Rowan

Centers for Medicare & Medicaid Services (CMS) publishes Home Health Agency (HHA) quality ratings using a composite 5-star system derived from seven assessment- and claims-based indicators. Because the ratings summarize agency-level averages, they can conceal quality differences across patient subgroups. Using national Medicare administrative, assessment, and claims data, this study simulates overall and subgroup-specific star ratings, evaluates their reliability, and tests informativeness of disaggregated measures.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Abstract

Purpose

Methods

Key Findings

Implications for Quality Measurement

Innovation in Aging, 2025, Vol. 9, No. S2 1145 Abstract citation ID: igaf122.3840 REVEALING WITHIN-AGENCY VARIATION IN MEDICARE HOME HEALTH QUALITY RATINGS Shekinah Fashaw-Walters1, Olga Jarrín2, and Anum Zafar2, 1. University of Pennsylvania, Philadelphia, Pennsylvania, United States, 2. Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States The Centers for Medicare & Medicaid Services (CMS) publicly reports Home Health Agency (HHA) quality ratings using a composite 5-star system based on seven assessment- and claims-based quality indicators. These ratings are intended to guide consumer decision-making and encourage performance improvement among providers. However, because the ratings reflect agency-level averages, they may mask important variation in the quality of care delivered to different patient subgroups. This study examines within-agency variation in reported performance using national Medicare administrative, assessment, and claims data. We applied CMS’s published star rating methodology to simulate overall and group-specific quality ratings and assess the reliability and informativeness of disaggregated quality ratings. Our findings show that agencies with average to high overall ratings (3–5 stars) can exhibit substantial variation in care outcomes across patient subgroups. This variability is obscured in the reported rating, limiting its utility for some consumers and stakeholders, typically those from marginalized groups. By identifying patterns of intra-agency variation, this analysis highlights opportunities to enhance the information provided by publicly reported quality measures to increase usability for all patient groups. These refinements could better equip consumers to make informed choices and support data-driven improvement efforts among providers. This work demonstrates the feasibility of generating more detailed quality information using existing administrative data sources and methods. These findings provide timely insights into how quality measurement tools can evolve to capture meaningful variation across different patient populations—enabling a clearer understanding of what works best, for whom, and under what conditions.

FAQs

What do CMS Medicare Home Health Agency (HHA) star ratings represent?

They are composite 5-star ratings based on seven assessment- and claims-based quality indicators reported by CMS.

Why might reported HHA quality ratings be misleading for consumers?

Agency-level averages can mask substantial quality variation across patient subgroups, reducing usefulness for some stakeholders, especially marginalized groups.

How does the study assess within-agency variation?

It applies CMS’s published star rating methodology to simulate overall and group-specific quality ratings using national Medicare administrative, assessment, and claims data.

Sep 28, 2026

Uploaded by Rowan