Centers for Medicare and Medicaid Services: Home Health Quality Measures Explained

The Centers for Medicare & Medicaid Services (CMS) is part of the federal government's Department of Health and Human Services. Because many Medicare and Medicaid recipients are elderly, much of the funding goes to nursing homes or eldercare services. Home health agencies that receive certifications from Medicare undergo an assessment every three years. CMS assesses these home health agencies via quality measures and publishes each agency's results.

CMS & Home Health

CMS provides scoring for all Medicare-certified home health agencies via Home Health Compare. The quality measures take into account: (1) the patient's improvement in performing a variety of activities of daily living (ADLs), and (2) whether the patient's health improves or stabilizes over time.

It is important to note that the quality measures should only be used as a general guide. Many home health care recipients are elderly, and each patient's needs are different. Some patients are recovering from surgery or a medical emergency. Others have chronic and worsening medical conditions. Therefore, the lack of improvement in some home health care recipients is not due to poor standards or substandard care, but rather due to declining health. In addition, Medicare's quality measures for home health are fairly recent and are still being refined. Currently, the quality measures provide a baseline to help consumers see how a local agency compares to both state and national averages.

CMS Quality Measures

CMS quality measures are used in Medicare-certified home health care agencies in order to come up with the final scoring. Medicare details the following quality measures:

  • Three measures related to improvement in getting around:
    • Percentage of patients who get better at walking or moving around
    • Percentage of patients who get better at getting in and out of bed
    • Percentage of patients who have less pain when moving around
  • Four measures related to meeting the patient's activities of daily living:
    • Percentage of patients whose bladder control improves
    • Percentage of patients who get better at bathing
    • Percentage of patients who get better at taking their medicines correctly (by mouth)
    • Percentage of patients who are short of breath less often
  • Two measures about how home health care ends:
    • Percentage of patients who stay at home after an episode of home health care ends
    • Percentage of patients whose wounds improved or healed after an operation
  • Three measures related to patient medical emergencies:
    • Percentage of patients who had to be admitted to the hospital
    • Percentage of patients who need urgent, unplanned medical care
    • Percentage of patients who need unplanned medical care related to a wound that is new, is worse, or has become infected