A recent article in underscores some of the problems with the star rating system for home care. According to the article, four home care agencies run by Brookdale Senior Living – in Florida, North Carolina, Ohio and Rhode Island – each earned five stars, the top quality score yet none of the four earned more than a two star rating from the patients who rated the agencies. There appears to be a disconnect between what agencies self report and what patients think.
Dr. Joanne Lynn, a geriatrician at the Altarum Institute, a nonprofit research and consulting firm, said much of a patient’s health was beyond the control of home health workers, who can visit as infrequently as once every two weeks.
“Medicare-covered home health services are so limited, and what they are measuring includes a number of things that, for many people, are not fixable,” she said, referring to metrics assessing how often patients got better in their daily activities.
Instead, she said, poor ratings for an agency may reflect an absence of other important services in a region. “If you’re in an area that doesn’t have a lot of advanced care planning, has a yearlong waiting list for Meals on Wheels, and no doctors who are able to visit people at home, you’re going to be stuck with sending sick people back to the hospital,” Lynn said.
Margaret Murphy, associate director of the Center for Medicare Advocacy, a nonprofit that aids Medicare beneficiaries seeking health services, said she fears that agencies that avoid particularly sick patients may end up looking better in the ratings.
“We find that agencies don’t want to take those people on,” she said. “They can get someone who has just come out of a hospital, maybe after a heart attack and they need a little bit of watching to get back on their feet, maybe they need a little bit of therapy. But they’re going to go back to their regular life, as opposed to someone with Parkinson’s, who is losing strength and losing balance. They are a big burden on agencies.”
It is not clear how many patients use Medicare’s star ratings and whether those who do, understand them. Lee said, “If you have patients who are very sick, the question is to what extent will they be in a position, because of their health, to really look extensively at this kind of information.”
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