By Bob Moos/Southwest regional public affairs officer for the U.S. Centers for Medicare and Medicaid Services
Medicare has just begun publishing star ratings for home health care agencies to help consumers tell the good providers from the bad.
Medicare pays for health care you receive in the comfort and privacy of your home if you meet certain requirements. You must be homebound, under a physician’s care and in need of part-time skilled nursing care or rehabilitative services.
One in 10 people with traditional Medicare relies on home health services in a given year. A third of all home visits are for patients released from the hospital but still requiring attention. The other two-thirds are for people trying to stay out of the hospital in the first place.
Medicare’s website – www.medicare.gov – is a convenient place to begin your search for a home health agency. With a few clicks, you can compare the providers in your area, check on the types of services they offer and the quality of their care.
To help you understand the differences in quality between agencies, Medicare has added star ratings to its website. One star means “poor,” two stars are “below average,” three stars mean “average,” four stars are “above average,” and five stars mean “excellent.”
Medicare has posted star ratings for more than 9,000 home health agencies nationwide, based on such quality measures as how quickly home visits begin after a doctor authorizes them and how often a patient improves under the home-based care.
About half of Texas’ 1,694 rated home health agencies are performing at or above average levels. Statewide, 17 percent received four or five stars, while 32 percent rated three or 3.5 stars. The remaining 51 percent scored 2.5 stars or lower.
The current ratings are based on the providers’ work from last year and will be updated regularly. Medicare didn’t rate some agencies because they didn’t have enough patients to evaluate or because they had only recently started their businesses.
While very useful, the star ratings aren’t meant to be the final word on a provider’s quality of care. They’re simply a screening tool that helps you focus on a few facilities. Visit with your doctor and talk to family members and friends who have had home health care.
Understanding home-based care is essential to finding the agency that best fits your needs.
Your home care starts with your doctor’s decision that your illness or injury demands it. You may need a skilled nurse to give you IV drugs, shots or tube feedings, or to change dressings, or to teach you and your caregivers about newly prescribed drugs.
You also may require rehabilitative services, like occupational, physical or speech therapy, to become as self-sufficient as possible and regain your independence.
The home health agency you select will work with you and your doctor to develop a plan of care. That plan will detail the services you need, how often you should have them, who will provide them, and what results your doctor expects from your treatment.
To qualify for home health benefits, your nursing care must be part-time. Home health aides who help with bathing and dressing, as well as homemaker aides who clean or do laundry, may be covered, but only if they’re part of your overall plan of care.
Medicare pays 100 percent for your care as long as you’re eligible. It also pays for 80 percent of any medical equipment you need, such as a special bed or oxygen.
If you’re in Medicare’s traditional fee-for-service program and have questions about your home health care coverage, you can call Medicare at 1-800-633-4227. If you’re in a private Medicare Advantage health plan, you should consult that plan.
Home health care can be a blessing by speeding your recovery after a hospital stay or, even better, by allowing you to avoid the hospital altogether. The new star ratings at www.medicare.gov will help you make an informed choice.