F-13-901 5 Star and Value Based Purchasing Overview
The Centers for Medicare and Medicaid Services (CMS) has implemented programs to evaluate and compare home health agencies on specific quality measures.
There are two main programs that are defined in this document: The 5 Star rating or Home Health Compare program and the Value Based Purchasing Program.
Descriptions of Programs:
5 star or Home Health Compare (5 Star):
A program that CMS created for consumers to compare home health agencies against each other in specific measures on a website. The more stars (from 1 to 5) the higher the rating. The site, https://www.medicare.gov/care-compare/ compares multiple services such as nursing homes, hospitals, clinics and a number of other settings as well as home care. For home health, the comparison consists of quality measures and patient satisfaction.
The specific measures that make up 5 Star quality component are:
1. M1860 Ambulation
2. M1850 Transferring
3. M1830 Bathing
4. M2020 Management of Oral Medications
5. M1400 Dyspnea
6. Timely Initiation of Care
7. Potentially Preventable Hospitalization rate
The patient satisfaction component is comprised of the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) which is a survey with standard questions that ask about care and service from the aspect of the client. We contract with a company to randomly send these surveys to our clients throughout their care with us. Similar to the oasis component, we are also rated on a 5 Star rating system.
Value based purchasing (VBP):
A program created by CMS to compare home health organizations against each other by comparing specific quality measures. This program has a monetary bonus, or penalty, depending on if the agency is above or below 50% of the other agencies. The bonus can range from 0 to 5%, or penalty can range from 0 to -5%, depending on how our total performance score (total score of all the measures) compares to others.
The specific measures that make up VBP are:
1. M2020 Management of Oral Medications
2. M1400 Dyspnea
3. M1810 Upper Body Dressing
4. M1820 Lower Body Dressing
5. M1830 Bathing
6. Potentially Preventable Hospitalization rate
7. Discharge to Community - kept the client out of the hospital for 31 days after we discharge
8. Discharge Function Score- improvement in the GG items
9. HHCAHPS- two out of five categories- (Overall Rating of the Home Health Agency and Willingness to Recommend that Agency included)
10. Medicare Spending per Beneficiary
Both these programs:
1. Compare home health agencies against each other
2. Use Oasis items to evaluate the performance of the home health agency. Some of the measures are the same and some are different, but both come from how we score the Oasis.
3. Use client satisfaction data (HHCAHPS) to evaluate the performance of the home health agency. Some of the measures are the same and some are different but both come from the survey.
The programs differ:
1. With 5 Star, there is a website and VBP there is not.
2. With VBP, there is a monetary component attached, and 5 Star does not have a monetary component, it is a posted comparison.
Helpful Tips:
- Review the questions of the HHCAHPS survey. By understanding these questions, we are more likely to focus efforts on the specific areas that matter to the client so they feel heard and involved in their treatment plan and have a better experience with our agency.
- Review the accurate coding of the Oasis items. It is critical that we score these accurately at all timepoints.
- A main goal of home care is keeping the client out of the hospital.
📅 Effective: 12/29/25 | 🛠️ Revised: | ✅ Approved: JM