What’s the value of a home health star rating on Care Compare? Not as high as you may think, according to a new study released this week.

Researchers who analyzed nearly 23 million patient outcomes before and after the introduction of the Centers for Medicare & Medicaid Services’ star ratings in 2015 found a bit of an incongruity: While home health agencies in their self-reporting recorded functional improvement in patients, claims-based (i.e., more objective) measures found corresponding increases in hospitalizations and less timely initiation of care.

So what gives? Are home health agencies skewing their observations about improvements in ambulation, bathing and bed transferring to juice their star ratings? Or could it be something more subtle – that humans are, well, human, and their observations vary based on the intelligence and abilities of the people assessing the patients?

It might just be a little bit of both. After all, there is a reason why CMS made the Quality of Patient Care Star Ratings a composite of both Outcome and Assessment Information Set (OASIS) assessments, which are based on agency-reported data; and Medicare claims data, which is claims-based. CMS clearly thought it was important for the ratings to reflect, in part, the subjective feedback and observations of people actually seeing and serving the clients.

No doubt the federal agency wrestled with an ideal algorithm for determining how patients are faring. Because healthcare is the science of treating people, it is far from perfect. Caregivers and patients have good days and bad days. The latter may unwittingly deceive those around them in their recovery paths. (How many times have you seen someone looking healthy and robust suddenly decline?) Observational mistakes, therefore, are bound to happen. 

And undeniably, a home health agency is a financial entity, which needs to generate money. If it holds the key to a higher rating — and more clients — through self-reporting, there is hardly an incentive for complete transparency. 

CMS likely foresaw these challenges when it incorporated agency observations into the star ratings formula. It ultimately determined that claims-based measures do not tell the whole story.

The downside, inevitably, is when you are relying on humans and their judgments — and the Greek gods knew this all too well — there are bound to be limitations.

Liza Berger is editor of McKnight’s Home Care. Email her at [email protected].