How Does Medicare Ensure Quality of Home Health Care Services?

Medicare ensures the quality of home health care services through a comprehensive system of regulations and certifications upheld through inspections and quality improvement programs. By setting and enforcing standards, Medicare aims to regulate the quality and safety of care beneficiaries receive at home. 

Medicare sets strict standards for home health agencies to ensure they provide high-quality care for their patients. These agencies must comply with the Medicare Conditions of Participation (CoPs), which cover a wide range of operational, clinical and administrative practices. To participate in Medicare and receive Medicare reimbursement, home health agencies must be certified. This process involves regular inspections that state agencies or accreditation organizations approved by the Centers for Medicare & Medicaid Services (CMS) conduct. 

These inspections assess compliance with CoPs, ensuring that home health agencies meet the necessary quality and safety standards as required by Medicare. With these measures in place, seniors and families can have confidence when searching for home health agencies in their area.

Medicare uses improvement programs and performance measures to enhance the quality of home health care services. The Home Health Quality Reporting Program (HHQRP) requires home health agencies to submit data on various quality measures in three categories:

• Outcome Measures: Assesses the results of health care experienced by patients, including improvement measures, potentially avoidable events, utilization of care and cost/resource measures
• Process Measures: Evaluates the rate of care processes, including timely initiation of care, drug education, influenza immunization and health information transfers
• Patient Reported Outcome Measures: Gathers feedback from home health care patients based on a 34-question Home Health Care CAHPS Survey, detailing their experiences and outcomes.

These measures help track the effectiveness of care and identify opportunities for improvement. Additionally, the Home-Health Value-Based Purchasing Model incentivizes agencies to improve their quality of care by tying payment adjustments to their performance on specific quality measures.

To further ensure quality, Medicare publishes performance data on its Care Compare website. This site allows patients and their families to search for home health agencies in their area and compare them based on quality scores. Tools such as star ratings help summarize health care provider performance measures, making them easier to understand. The two types of star ratings include:

• Quality of Patient Care Star Ratings
• Patient Survey Star Ratings

This transparency helps consumers make informed decisions about their care providers.

Additionally, Medicare provides resources and support for home health agencies to improve their services. For example, the Quality Improvement Organization Program offers technical assistance and education to help agencies enhance their care quality. This program uses data to track health care quality improvements, protect the integrity of Medicare fund usage and address individual complaints.