Everyone wants more referrals but even the best marketer in the world is at a loss when the agency marketed is a two-star outfit.  Whether it’s Amazon or TripAdvisor, people are making purchasing decisions based upon Star Ratings.  The same holds true for insurance companies and hospitals.  They want the next provider of care for their patients to be five star agencies and yet, only three percent of agencies meet that criteria for quality of care issues.

Four stars are good, too and three stars is an indication that agency is trying.  One and two star agencies are often overlooked and discharge planners will try to find a patient an alternative if they choose one.   Remember, the hospitals are penalized for readmissions.  There’s no denying that star ratings are a powerful weapon in the fight for referrals in markets where competition is tough.

So, have you figured out that you need to improve or maintain your Star ratings?  Are you wondering where to begin?  Here’s your answer.

First, know what data factors into your star ratings.   There’s exactly nine of them.

Process Measures:

1. Timely Initiation of Care
2. Drug Education on all Medications Provided to Patient/Caregiver
3. Influenza Immunization Received for Current Flu Season

Outcome measures:

1.  Improvement in Ambulation
2. Improvement in Bed Transferring
3. Improvement in Bathing
4. Improvement in Pain Interfering with Activity
5. Improvement in Shortness of Breath
6. Acute Care Hospitalization

Next, go to Medicare’s Home Health Compare page.  Find your agency and see which of these questions falls short of the national and state averages.  Begin with a plan to address the three worst and set it motion.  If you fall short in Drug Education, move it to the top of the list even if there are three more that are worse.  Poor compliance to medications will affect all the other outcomes.

Easy, right?  Your plan should look like a state survey plan of corrections with columns for the Star Factor, Interventions. Responsible Party and Follow-Up.  There should be one person who oversees the plan and that person should be a cheerleader and have the authority to call meetings.  He or she should be meticulous about follow-up and be respected by his or her peers.  If you don’t have a person like that, hire one because they will come in handy in a lot of different ways.

This is data taken from a random agency’s online published data.  It was easy to find because searches on the Home Health Compare site list all agencies that meet your criteria with their star ratings.  The last two columns are state averages and the National Average.

How often patients got better at walking or moving around	56.6%	69.6%	70.2%
How often patients got better at getting in and out of bed	51.6%	64.2%	67.1%
How often patients got better at bathing	71.5%	74.6%	73.6%
How often the home health team made sure that their patients have received a flu shot for the current flu season	22.3%	69.6%	74.4%

There are actually two types of outcomes reflected.  The first three all depend on two points in time.  The last one – flu shots – is defined by only the discharge or transfer OASIS.

People unfamiliar with OASIS may look at these outcomes and wonder what is wrong with the people running that agency.  Who could blame them?  I’m a little more cautious in judging this agency.  In fact, I am betting that the problem is OASIS data collection which hurts the agency more than the patient.

If this agency wanted to improve their star ratings, they might have an action plan that included some of the following interventions.

Education regarding the functional domain.

• The importance of assessing rather than interviewing patient
• The importance of reading physician or hospital notes on admission
• Review of Medications to determine if any meds would render the patient unsafe to ambulate, transfer or bathe. If they are PRN meds, the nurse should review how often they are taken.  Remember to include antihypertensives, antihistamines, and other meds and the length of time the patient has been taking them.
• A visit to the bathroom and bedroom to assess for structural barriers

Education of the OASIS conventions that affect the functional domain

• Know what a ‘day’ is in OASIS land – the 24 hours prior to the visit and the visit itself.
• Consider safety
• Understand the ‘majority of tasks’ instructions in the conventions.

Discharge to Community Review

• Determine if a discharge visit has been made. When a visit is not possible, the OASIS data must be taken from the last OASIS assessment.  Short lengths of stay will reflect a ‘static’ patient with no changes.
• Determine if information on discharge conflicts with information on admission. Example:  The admit nurse noted the dates of pertinent immunizations and the discharge assessment states that vaccination status was not addressed indicating that a chart review was not performed.
• Considering the course of care for the patient, was the admission assessment correct. All admission, resumption of care and recertification assessments resulting in a score of F1 in the HHRG should be reviewed for accuracy.  The very low score could indicate that the patient is not homebound or the clinician did not understand how to answer the questions.  Both possibilities need to be explored and explained.

Review of the OASIS data regarding flu shots.

If I could only choose one outcome to improve it would be the frequency that the agency assessed for flu shots.  It is easy and does not require a lot of agency resources to monitor and manage.

• For this question, dates are critical. Any patient admitted after March 31 and discharged prior to April 1 should not be reflected in this question.  Ensure that the clinician answers ‘No” to:

(M1046) Influenza Vaccine Received: Did the patient receive the influenza vaccine for this year’s flu season?

• The time frame under consideration is an episode of care.  An episode of care, often confused with a payment episode, begins upon admission and ends on transfer or discharge UNLESS the patient is hospitalized. If that happens, a new care episode will begin at Resumption of Care and continue to discharge or the next transfer.

Understanding these concepts will not only improve outcomes but they will also increase payment in some instances and the integrity of your data will be maintained or heightened.  Because payment system recommendations are made based on the data that agencies submit, everyone has the responsibility to submit accurate data.

Call us if you need help with understanding and monitoring your Star ratings.  It takes a while to wash out old data but sharing your data with your staff on a quarterly basis as it becomes available will go a long way motivating your staff to pay close attention to the OASIS data.  Better yet, your marketers will be armed with an explanation of why your agency pales in comparison to others and be able to tell prospective referral sources your plans for improvement.