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The Home Health Compare results were updated on January 26, 2017.

Nearly all national averages for the Quality of Patient Care measures showed improvement except multifactor fall risk assessment conducted which remained unchanged. Measures with the greatest improvement were diabetic foot care and patient education implemented and improvement in ambulation. The data collection period for these measures is from July 1, 2015 to June 30, 2016.

All quality measures included under Value-based Purchasing showed improvement except for the acute care hospitalizations which worsened slightly (collection period April1, 2015 to March 31, 2016). This measure remained at 16.0% from January to July 2016 and worsened in October 2016 to 16.2%, and then again to 16.3% this data collection period.

All national averages for HHCAHPS measures remained the same as last quarter. The data collection period for these measures is from July 2015 to June 2016.

Six measures were dropped from Home Health Compare public reporting this quarter per the final 2017 HH PPS rule; pain assessment conducted, pain interventions implemented, pressure ulcer risk conducted, pressure ulcer prevention included in the plan of care; pressure ulcer prevention implemented, and heart failure symptoms addressed.

The Patient Care Star Ratings showed an increase of agencies in the 2.5 star rating category, and an decrease in the number of agencies with 4.5 stars. The national average Star Rating remained the same at 3.0 stars.

Visit our Home Health Compare page with drop downs to compare by state, by year, and by release date. You can also select comparisons for the top 10 percent or top 20 percent. We also provide a drop down to agency level for Star Ratings.

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According to releases from the National Center for Health Statistics, the leading causes of death in 2014 remained the same as in 2013. However, age-adjusted death rates for five leading causes declined significantly; heart disease, cancer, chronic lower respiratory diseases, diabetes, and influenza and pneumonia. Although not in the top ten leading causes, hypertension also showed a significant decrease. Death rates increased significantly for unintentional injuries, stroke, Alzheimer’s disease, suicide, and chronic liver disease and cirrhosis between 2013 and 2014.

  • Generally, for younger age groups, external causes accounted for more deaths than other causes, whereas for older age groups, chronic diseases were far more prevalent than other causes.
  • For populations aged 65 and over, heart disease was the leading cause of death, followed by cancer. 
  • Heart disease was also the leading cause of death for the population aged 85 and over.
  • Alzheimer’s disease was one of the major causes of death at the oldest ages, ranking third for those aged 85 and over.
  • Medicare beneficiaries with six or more chronic conditions account for 15% of beneficiaries but 50% of total Medicare spending (see chart below).

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Clearly the data shows the impact of our aging population and chronic care needs. Fazzi uses the IHI Triple Aim framework when assisting agencies with preparing for the future now. To learn more about Triple Aim, click here.

To download a PDF of the top ten home health and hospice diagnoses from analysis of Fazzi claims data, click here.  To download a PDF of leading causes of death for three age groups; 65-74 years, 75-84 years, and 85 years and over, click here.  For chronic condition prevalence at state and county levels, click here.

Leading causes of death. For information on data and methods, including definitions of and procedures for ranking, see sources: Heron M. Deaths: Leading causes for 2014. National vital statistics reports; vol 65 no. 5. Hyattsville, MD: National Center for Health Statistics. 2016. Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016. Medicare spending on chronic conditions. See Centers for Medicare and Medicaid Services, chronic conditions charts: 2014.

 

The Home Health Compare results were updated on October 19, 2016.

Nearly all national averages for the Quality of Patient Care measures showed improvement with pneumococcal polysaccharide vaccine ever received and influenza immunization received for current flu season showing the most improvement. Only two measures remained the same; pressure ulcer risk conducted and depression assessment conducted. The data collection period for these measures is from April 1, 2015 to March 31, 2016.

All quality measures included under Value-based Purchasing showed improvement except for the Preventing Unplanned Hospital Care measures. The quality measures for acute care hospitalizations and urgent, unplanned care in the emergency room both worsened slightly this quarter (collection period January 1, 2015 to December 31, 2015).

All national averages for HHCAHPS measures remained the same as last quarter. The data collection period for these measures is from April 2015 to March 2016.

hhc-chart-10-16The Patient Care Star Ratings showed an increase of agencies in the 4.5 and 5 star rating categories, and an increase in the number of agencies with 1.5 to 2.5 stars. The number of agencies with 3, 3.5, and 4 stars decreased. The national average Star Rating remained the same at 3.0 stars.

Visit our Home Health Compare page with drop downs to compare by state, by year, and by release date. You can also select comparisons for the top 10 percent or top 20 percent. We also provide a drop down to agency level for Star Ratings.

The Home Health Compare results were updated July 18, 2016.

Nearly all national averages for the Quality of Patient Care measures showed improvement with only one measure showing a decline. The data collection period for these measures is from January 1, 2015 to December 31, 2015.

  • Overall Quality of Care Star Rating: Remained the same at 3.0 stars.
  • Managing Daily Activities: All measures showed improvement.
  • Managing Pain and Treating Symptoms: Four measures showed improvement and pain assessment conducted remained unchanged.
  • Treating Wounds and Preventing Pressure Sores: All measures showed slight improvement.
  • Preventing Harm: Depression assessment conducted remained unchanged. Influenza immunization received for current flu season showed a slight decline.

The data collection period for Preventing Unplanned Hospital Care is October 1, 2014 to September 30, 2015. The quality measure for acute care hospitalizations remained unchanged while urgent, unplanned care in the emergency room worsened slightly this quarter from 12.3% to 12.4%.

For HHCAHPS averages, the national score for patient willingness to recommend the HHA to family and friends decreased for the first time in a long time. If you have not already read our latest white paper, Key Drivers & Best Practices for Improving HHCAHPS Results, you may download it by clicking here. The remaining measures are unchanged. The data collection period for these measures is from January 2015 to December 2015.

Visit our Home Health Compare page with drop downs to compare by state, by year, and by release date.  You can also select comparisons for the top 10 percent or top 20 percent.  We also provide a drop down to agency level for Star Ratings.

The Home Health Compare results were updated April 20, 2016.  Nearly all measures showed improvement.  Four measures remain unchanged while one measure decreased.  The data collection period for these measures is from October 1, 2014 to September 30, 2015.

hhc-star-2016-04

Seven of the nine measures for the Quality of Patient Care Star Ratings showed improvement.  Influenza immunization received for current flu season decreased for the second reporting period in a row and Acute Care Hospitalization remained unchanged.  The nine measures used to calculate the star ratings are identified with an asterisk on Fazzi’s Home Health Compare Charts.  The Quality of Patient Care Star Ratings show 22% of agencies receiving 3 and 3.5 stars.

For HHCAHPS averages, the national score in Specific care issues decreased.  The remaining measures are unchanged. The data collection period for these measures is from October 1, 2014 to September 30, 2015.

Check your Patient Survey Star Ratings.  If your star rating decreased, contact our Gina Mazza, our HHCAHPS Survey Director for improvement tips.

Visit our Home Health Compare page with drop downs to compare by state, by year, and by release date.  You can also select comparisons for the top 10 percent or top 20 percent.  We also provide a drop down to agency level for Star Ratings.

Home Health Margins and Volume Quintile
Quintile 2011 2012 2013 2014
First (Smallest) 6.6 7.1 6.1 4.0
Second 8.3 8.1 7.8 5.4
Third 10.1 10.1 8.9 7.6
Fourth 13.4 13.2 11.2 10.0
Fifth (Largest) 17.4 16.8 14.8 12.5
Sources: MedPAC Report to the Congress: Medicare Payment Policy, March 2014 and 2016 and MedPAC June 2014 and June 2015 Data Book.
Medicare Margin 2014
All Freestanding HHAs 10.8%
Majority urban 11.2%
Majority rural 8.5%
For profit 12.2%
Nonprofit 6.4%

Freestanding home health agencies had an aggregate margin of 10.8 percent in 2014. MedPAC estimates the marginal profit of HHAs to be 13.3 percent in 2014, about 20 percent higher than the overall Medicare margin.

“[MedPAC] includes hospital-based HHAs in the analysis of inpatient hospital margins because these agencies operate in the financial context of hospital operations. Margins for hospital-based agencies in 2014 were -22.4 percent. The lower margins of hospital-based agencies are chiefly because of higher costs, some of which may be due to overhead costs allocated to the HHA from their parent hospitals.

“On the basis of these policies and assumptions, [MedPAC] projects a margin of 8.8 percent in 2016. This projection assumes that the sequester reduction of 2 percent remains in effect through 2016.”

Sources: MedPAC Report to the Congress: Medicare Payment Policy, March 2014 and 2016 and MedPAC June 2014 and June 2015 Data Book.

Hospice Margins and Volume Quintile
Quintile 2010 2011 2012 2013
First (Smallest) -6.5 -4.1 -2.3 -0.3
Second 2.0 2.8 5.9 6.0
Third 4.5 7.5 9.7 9.4
Fourth 6.8 9.9 11.2 11.2
Fifth (Largest) 9.0 9.6 10.6 8.3
Source: MedPAC Report to the Congress: Medicare Payment Policy. March 2016.

In 2013, the average hospice Medicare margin was 8.6%. Freestanding hospices had higher margins (12%), while home health based hospices averaged 2.2% and hospital-based -16.7%.

Source: MedPAC Report to the Congress: Medicare Payment Policy March 2016.

Source: CMS Moratoria Provider Services and Utilization Data Tool
State Number of Agencies Patients per Agency Agencies per County
Alabama 145 475 9
Alaska 10 211 3
Arizona 137 287 48
Arkansas 153 225 6
California 1,127 256 204
Colorado 122 273 20
Connecticut 86 563 32
Delaware 23 581 14
District of Columbia 33 156 33
Florida 1,059 293 73
Georgia 113 722 9
Hawaii 12 228 5
Idaho 45 292 7
Illinois 772 218 256
Indiana 203 288 19
Iowa 147 169 5
Kansas 120 216 10
Kentucky 108 509 6
Louisiana 200 331 18
Maine 30 637 6
Maryland 63 1,015 17
Massachusetts 144 720 40
Michigan 552 245 110
Minnesota 142 263 14
Mississippi 48 1,141 5
Missouri 178 340 17
Montana 27 218 2
Nebraska 67 223 9
Nevada 118 222 68
New Hampshire 37 568 12
New Jersey 56 1,695 11
New Mexico 73 213 8
New York 147 1,101 19
North Carolina 178 560 10
North Dakota 19 190 2
Ohio 447 244 30
Oklahoma 255 249 29
Oregon 67 331 7
Pennsylvania 317 434 26
Rhode Island 29 440 21
South Carolina 75 726 7
South Dakota 30 155 3
Tennessee 145 492 12
Texas 2,176 140 157
Utah 93 211 31
Vermont 14 711 3
Virginia 205 440 17
Washington 65 645 10
West Virginia 63 354 5
Wisconsin 101 350 8
Wyoming 28 128 2
National 10,377 314 60

CMS has released the Moratoria Provider Services and Utilization Data Tool which includes national, state and county level provider services data for home health. We’ve extracted the data by state for the number of home health agencies, average number of patients served per agency, and agencies per county.

The data shows that between October 1, 2014 to September 30, 2015, there were 10,377 Medicare-certified agencies serving a national average of 314 patients each and an average of 60 agencies per county.

States with an active moratorium have greater than 64 agencies per county along with other indicators of potential fraud risk, including the number of providers per 10,000 Medicare FFS beneficiaries and the annual growth rate in providers.

You can access the CMS Moratoria Provider Services and Utilization Data Tool and view additional data by state.

Do you want to know the number of patients your competitors are treating? Or how many counties they serve? Visit our Business Intelligence web page or contact us to learn how you can compare your patients. For Medicare beneficiary data, visit our post-acute care use web page.

Note: In the CMS analysis, claims are used to define the geographic area(s) served by a provider rather than the provider’s practice address. Further, a provider is defined as “serving a county” if, during the one-year reference period, the provider had paid claims for more than 10 beneficiaries located in a county. A provider is defined as “serving a state” if that provider serves any county in the state.

Lynn Harlow
Partner, Director of Business Intelligence

The Home Health Compare results were updated January 28, 2016.

  • This release includes the first reported Home Health Patient Experience of Care Star Ratings. The HHCAHPS Patient Survey Star Ratings reports patients’ experiences of care ranging from one to five stars. CMS reports approximately 6,000 agencies with patient care experience star ratings in this release. Four HHCAHPS measures can receive a star rating plus there is a summary star rating that reflects the average of the composite stars and global star.
    •  3 composites measures: care of patients, communication between providers and patients, and specific care issues
    • 1 global item: Overall rating of care provided by the HHA
    • 1 Survey Summary Star Rating

CMS has adjusted the Patient Survey Star Ratings results for patient mix. The adjusted results are publicly reported.

Read full article, Home Health Compare Charts Updated