U.S. News launches first ratings of home health agencies

After more than three decades of rating hospitals, U.S. News & World Report is looking a little closer to home.

For the first time, U.S. News is publishing ratings of America’s home health agencies. The inaugural list was published today. U.S. News examined more than 12,000 home health agencies certified by Medicare, and 1,319 earned recognition as “Best Home Health” agencies.

In addition, 5,288 agencies were identified as meeting U.S. News’ standards for providing quality care and a good patient experience.

Ben Harder, chief of health analysis and managing editor at U.S. News, tells Chief Healthcare Executive® that the first-ever ratings of home health agencies reflect their growing importance to patients.

“Health systems and patients and families have become more and more attuned to what happens to patients after their hospitalization,” Harder says. “Hospitalizations are shorter than ever. … The care that's provided to patients in the post-acute setting after they've been discharged is more important than ever.”

Avoiding readmission

Hospitals and health systems have a stake in the quality of care delivered by home health agencies, since hospitals can face financial penalties if too many patients need to be readmitted.

“For health systems that are trying to manage things like readmission penalties, that's an important marker of quality and of financial performance as well,” he says.

“They don't want to see patients bouncing back if they've discharged the patient to home health,” Harder says, “The principle is that patient's going to recover in the comfort of their home with visiting nurses or physical therapists or whatever it is that they need in that setting and that they shouldn't need subsequent hospital care during their their home health episode. So hospitalization rate, especially potentially preventable hospitalizations, is a really important measure.”

Generally, home health agencies differed in their performance when it came to helping patients avoid a return trip to the hospital.

“We did see quite a bit of variation on that measure, between agencies that got the recognition as best home health agencies from U.S. News, and those that didn't,” he adds.

If one home health agency is seeing one in eight patients go back to the hospital, while another agency has one in 12 needing readmission, Harder says, “That's a pretty big difference, if you think about it.”

“You certainly want an agency that's going to manage your care and make sure that you're safe at home, and you don't need to receive additional care in the hospital,” he adds.

‘Important for families’

Of course, the quality of home health agencies matters to patients and their families.

“It’s critically important for families and patients because they're having less time to heal and recover in the hospital in general, and so more of that recovery and rehabilitation is occurring in settings like the home, or in post-acute care facilities, like nursing facilities and rehab facilities,” he says.

U.S. News examined data on home health agencies from the Centers for Medicare & Medicaid Services.

The top home health agencies began care on time for 99% of patients, surpassing the national average of 94%.

Harder says the beginning of care at home is a key benchmark. And those that are lagging in starting home health services should look to do better in that area, he says.

“That prompt initiation of care is critically important, because those first days outside the hospital is a period when patients can be really vulnerable,” he says.

The top-ranked home health agencies also succeeded in getting improved walking and movement from 93% of patients, also besting the national average of 83%.

The high-performing home health agencies also helped more patients achieve a greater degree of independence, including getting out of bed and bathing by themselves. They also helped ensure patients were taking their medications directly, which can be a challenge for patients who are taking several different drugs and at different times.

“Those activities of daily living are critically important to patients who may have experienced a really adverse health event, a stroke, sepsis infection, maybe they fell and had a hip fracture, spent time in the hospital, and then they're coming home,” Harder says. “Do they recover at least as much as possible of the function that allows them to live independently? And so that's a very important goal of home health and of all types of post-acute care.”

Agencies tied to hospitals

Many home health agencies are affiliated with hospitals, as health systems try to maintain more continuity of care, especially as patients spend less time in the hospital.

Harder said those home health agencies tied to hospitals typically delivered good care.

“Some hospital- or health-system-affiliated agencies did quite well,” Harder says. “I'd say, in general, many of them did, but not all of them. And there were also some independent agencies that did extremely well on the quality measures we evaluated.”

In theory, home health agencies affiliated with hospitals would offer some benefits for patients, including full access to electronic health records and visibility into notes from doctors and nurses.

“Whether that's actually the case or not, I think is something that we intend to look at more closely in the future,” Harder says.

While cities and suburban areas often boast of a number of home health agencies, those living in rural areas have fewer options, he says.

“When you start to get out into more rural areas, it may be more difficult to find home health availability in some of those communities,” he says.