The federal government is trying to make it easier for consumers to figure out who's good and who's not in a lesser-known part of the health care industry. For the first time, Medicare has released star ratings for home health agencies. The agencies consist of nurses, therapists and social workers who bring treatment to you. WFAE's Michael Tomsic reports on how agencies earn their stars – and potentially set themselves up for higher reimbursements in the future.
Annie Wilson isn't quite as active as she once was.
"I was a great square dancer back in my young days," she says with a laugh.
Now at 105 years old, she uses a walker to get around but wants to improve her balance. Physical therapist Kurt Harcar helps her to her feet and hands her a soccer ball.
"You're going to hold onto the ball, both hands," he says. "Now we want to go side to side."
"Like this?" she asks.
"Yep, and then over this way," he responds. "Good."
She also raises it up and down while Harcar supports her. He works for Brookdale Home Health Charlotte, and he treats patients at their homes in this south Charlotte retirement community.
"The big key that we try and focus on here is making sure they're safe and as independent as they can be," he says. "An exercise like that, it's designed to help her - let's say if she was in the bathroom reaching up to get soap, or reaching over to the side of the sink to get hand soap again or a wash cloth."
How often patients get better at moving around is one way Brookdale sets itself apart. It's also far above national averages on quickly initiating care and easing pain, according to Medicare data.
Harrison Brown of The Advisory Board Company, a consulting firm, says the federal government factored all that into the first star ratings in July.
"These metrics as a whole show home health's ability to improve somebody's function, and home health's ability to prevent costly episodes that are negative for the patient, like a hospitalization or like a delay in service," he says.
That's part of the reason Medicare is putting a brighter spotlight on home health – by keeping people out of the hospital, it can save the federal government money.
Brown says the new star ratings are good for consumers and the most effective agencies.
"This is really an opportunity for home health agencies to differentiate themselves, given that home health actually has a lot of variability in it in terms of quality and cost," he says.
For Brookdale Home Health Charlotte, its metrics add up to a five-star rating, the highest possible.
It's one of only two agencies in North Carolina to receive that honor. The most common rating is three stars, and only six agencies nationwide received one star, according to a Kaiser Health News analysis.
The ratings have limitations. Bill Dombi of the National Association for Home Care and Hospice says for one, they emphasize improvement.
"The population in home health tends to be fairly aged with multiple chronic illnesses, where stabilization may be the goal rather than improvement," he says.
Dombi says it's unrealistic for a patient with Parkinson's disease, for example, to get much better. But home health can help that person maintain some independence.
Another limitation is that the underlying data for the star ratings are self-reported, which creates potential for some agencies to pad their stats.
"You don't know what you're getting, and there is little quality oversight of the data," says Dan Mendelson, CEO of consulting firm Avalere Health.
He says the data need to improve before Medicare starts tying payments to the quality metrics, as it's already doing with hospitals.
"Some home health agencies are taking this very seriously and are getting really good real-time data and going in and collecting the data on patients that they see, and others aren't," he says. "That's the situation right now."
Brookdale Home Health Charlotte is getting real-time data. Nurses like Ginny Grenda use tablets to update patient information as they go.
"I don't hear near as much congestion as I did when we were listening last week," she told patient Larry Goelz as she listened to his lungs recently.
Goelz is coming off a hospitalization for pneumonia and congestive heart failure. To help his lungs recover, she’s given him a tool to practice blowing into.
It’s easy for Grenda to keep tabs on Goelz - she’s part of the Brookdale team that’s set up in this retirement community. She says that’s another thing that sets Brookdale apart.
"We are in the building, which helps," she says. "We see them intermittently. But if there is a complication, the staff can get us, and we can get orders to see the patient as needed."
Brookdale Home Health has teams set up in 22 retirement communities in the Charlotte area. That may give it an advantage in the star ratings over agencies that are constantly driving from home to home.
That said, the only other five-star agency in North Carolina, Well Care Home Health in Wilmington, mostly does serve private homes.
Brookdale’s director, Cheryl Engram, says the more important factors are how experienced her staff is and how well they know their patients. One nurse said she knows her patients like she knows her family.
"That speaks to me volumes about what we do and the services that we provide," Engram says. "Not just the fact that we've got a team of people here, but that the persons that make up that team are following through on the things that they need to do."
Engram says Brookdale is now looking to expand, and it’ll use its five-star rating as a selling point.
