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5 Reasons you don’t have a 5-star rating

Achieving a five-star rating in home health care is no simple task, especially with seemingly endless CMS regulations and measurements. And with the new preauthorization requirements, it’s not getting any easier.

While a low rating of one or two stars doesn’t necessarily equal low quality care, agencies touting five stars can certainly attest to the stellar reputation and bigger bottom line that the rating has helped them achieve. But what is keeping your home health agency from reaching these elusive five stars? Here are five reasons:

1. You lack a defined process.

If you spend more time on paperwork and documentation than you do on defining your workflow, you’re probably still striving for those five stars. The truth is, a five-star rating comes with a five-star method – and it needs to be adopted by your entire staff. CMS requirements on documentation and reporting mean that you not only need a system for collecting this data, but also consistency (and accuracy) among your caregivers as they input this information.

2. You’re not embracing technology.

Technology exists to make our lives easier – from streamlining your processes to educating your patients. In the healthcare industry, technology plays an important role in every step of the medical journey, and it should be no different when it comes to home health care.

With large numbers of patients comes large amounts of data and documentation. Technology – whether it’s home health software on an iPad or laptop, etc. – will not only simplify this information, but it will also streamline the way you collect it (which is something CMS will notice). With technology:

  • Processes can be streamlined – including referral input, signed orders from physicians, scheduling and educating patients on medications, conditions and progress.
  • Workflows can be created, potentially resulting in less human error.
  • Mobile caregivers can provide accurate, real-time updates.
  • Documentation can lead to outcome measurement, which will bring attention to what you do well and what can improve.

3. Speaking of measuring outcomes, you’re probably not doing that.

With your processes streamlined and technology in place to create an efficient workflow experience, measuring the results of these tools should be a no-brainer.

Create daily measurements to ensure goals are being met and analyze patient outcomes based on their conditions. This proactive approach to home health – the continuous effort to find what works and what doesn’t – is what distinguishes the organizations with quality patient care.

4. You focus on quantity over quality.

If you’re more concerned with accumulating patients and less concerned with enhancing the patient experience, your CMS rating is likely affected. Many agencies fail to realize the influence patient satisfaction has over their star rating. The Home Health Care CAHPS Survey (now a part of the CMS rating system) compares data on patient perspectives – ultimately increasing transparency of care quality, boosting accountability and creating incentives for agency improvement.

With a growing patient list should come quality growth – in both your internal process and your customer experience. Treating every new patient as an opportunity to provide even better quality will result in improved care and improved ratings.

5. You’re not collaborating with your referral sources.

Referral sources bring you new patients – and with new patients, come more opportunities to refine the way you do business. Simplify the way patient information flows between your agency and the physicians, case managers and discharge planners. Your streamlined process will make them want to continue working with you – leading to more referrals, improving your workflow and enhancing your placement within CMS requirements.

When approaching ways to enhance your home health agency, think of it as enhancing patient care. From the processes you put in place to the way you communicate with those overseeing their care, the end goal is to always give the patient a better experience – and CMS measurements are in place to make sure that attention to detail gets noticed.


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