Home Health Star Rating: What It Measures, How It’s Calculated, and Why It Matters

The home health star rating is a publicly reported quality indicator developed by the Centers for Medicare & Medicaid Services (CMS) and displayed on Medicare’s Care Compare website. The rating system converts standardized clinical outcomes and patient experience data into a one-to-five-star score, allowing home health agencies to be compared using consistent criteria.²

While the star rating appears simple, it is built on multiple data sources and statistical benchmarks. Understanding how the home health star rating is calculated—and what influences changes over time—helps agencies interpret results accurately and prioritize quality improvement efforts that align with CMS quality reporting expectations.

In this article, we’ll explain how the home health star rating works, what data contributes to it, how CMS calculates scores, and how agencies can use the information to support performance monitoring and quality initiatives.

What is the home health star rating?

CMS publishes two separate star ratings for home health agencies: a Quality of Patient Care Star Rating and a Patient Survey (HHCAHPS) Star Rating. Each rating reflects a different aspect of care and is calculated independently using national performance comparisons.²

Quality of Patient Care Star Rating

The Quality of Patient Care Star Rating is based on selected clinical quality measures derived from the Outcome and Assessment Information Set (OASIS) and Medicare claims data. These measures focus on patient outcomes during a home health episode, including changes in functional status and select care processes.

Measures included in this rating assess areas such as:

• Improvement in ambulation and mobility

• Improvement in self-care activities

• Management of symptoms

• Avoidance of unplanned hospitalizations

CMS groups these measures into performance domains and calculates a composite score that is converted into a star rating based on national score distributions.²

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HHCAHPS Star Rating

The HHCAHPS Star Rating is based on patient responses to standardized surveys that assess care experience. These surveys capture feedback related to communication, professionalism, and responsiveness during home health services.²

To receive an HHCAHPS star rating, agencies must meet minimum survey response thresholds. Agencies that do not meet these thresholds may still have survey data publicly reported without an associated star value.²

How the home health star rating is calculated

CMS uses a relative scoring methodology, meaning star ratings are determined by how agencies perform compared to peers nationwide rather than against fixed performance targets.

OASIS-based measure calculation

For the Quality of Patient Care Star Rating:^1,2

1. Individual OASIS measures are risk-adjusted.

2. Measures are grouped into performance domains.

3. Domain scores are standardized across agencies.

4. A composite score is calculated.

5. Star ratings are assigned based on national cut points.

Because this approach relies on national distributions, the score required to earn a specific star rating may change from year to year as overall performance shifts.

HHCAHPS survey scoring

The HHCAHPS star rating uses patient survey results that undergo case-mix adjustment and are compared against national benchmarks. Agencies must meet CMS participation requirements to receive a star rating for this component.²

Why home health star ratings change over time

It is common for agencies to see variation in their home health star rating even when internal workflows remain consistent. Several factors contribute to these changes.

National performance trends

Because star ratings are comparative, improvement across the home health industry can raise performance thresholds. An agency may maintain similar scores while still experiencing a change in star rating if national averages improve.²

Measure updates

CMS periodically updates the measures used in quality reporting, including revisions to OASIS items or changes in claims-based measures. These updates can affect how performance is weighted within the star rating methodology.^1,2

Data completeness and accuracy

Incomplete assessments, delayed submissions, or documentation inconsistencies can influence eligibility and scoring outcomes. Accurate and timely OASIS submission is a foundational requirement for quality reporting.¹

Patient population changes

Shifts in patient acuity, referral patterns, or service mix may influence outcome measures, even when care delivery practices remain stable. Although many measures are risk-adjusted, star ratings are based on relative national performance, meaning changes in patient populations can still influence how an agency compares to peers.¹

Using the home health star rating as a quality improvement tool

Although the star rating itself is a summary score, the underlying measure data offers more actionable insight when reviewed in detail.

Identifying measure-level patterns

Reviewing individual OASIS-based measures allows agencies to identify where performance differs from national benchmarks. Trends related to functional improvement or hospitalization rates may indicate opportunities to review assessment practices or care planning alignment.¹

Supporting education and documentation practices

Education focused on standardized assessment techniques and documentation accuracy supports data integrity, which directly influences reported quality measures.¹

Communicating performance transparently

Because home health star ratings are publicly displayed on Care Compare, agencies benefit from being able to explain what the rating represents, how it is calculated, and what factors influence change over time.²

Example scenario

An agency receives a three-star Quality of Patient Care Star Rating while maintaining higher HHCAHPS results. Review of OASIS measure-level data shows lower performance in ambulation-related improvement measures compared to national benchmarks.

By reinforcing standardized mobility assessment and documentation practices across clinicians, subsequent reporting periods show improved performance at the measure level, contributing to a higher composite score.

Why the home health star rating matters

The home health star rating does not capture every aspect of care delivery, but it remains a widely referenced quality signal. It reflects standardized outcome and patient experience data using CMS methodology and supports public comparison across home health agencies.²

Agencies that understand how the star rating is constructed—and look beyond the summary score—are better positioned to use the information meaningfully. In practice, the rating helps organizations interpret performance trends within the context of national benchmarks, identify measure-level patterns that may warrant closer review, distinguish patient experience performance from clinical outcome results, and support internal conversations about assessment consistency and documentation practices.

For organizations responsible for monitoring quality performance, consistency in OASIS assessment practices is a foundational consideration. Because OASIS data feeds directly into many Quality of Patient Care measures, variation in how items are assessed or documented can influence reported outcomes over time. Supporting clinicians with structured education and clear assessment guidance can help promote:

• More consistent OASIS item scoring across clinicians

• Greater confidence in the accuracy of reported quality data

• Improved alignment between clinical documentation and CMS quality reporting expectations

Medbridge’s OASIS solution supports this need through role-relevant education and resources that reinforce standardized assessment approaches across teams. By strengthening alignment between clinical documentation practices and CMS quality reporting expectations, agencies can better interpret star rating trends and support ongoing quality oversight.

References

1. Centers for Medicare & Medicaid Services. (n.d.). Home health quality measures. U.S. Department of Health & Human Services. https://www.cms.gov/medicare/quality/home-health/home-health-quality-measures

2. Centers for Medicare & Medicaid Services. (n.d.). Home health star ratings. U.S. Department of Health & Human Services. https://www.cms.gov/medicare/quality/home-health/home-health-star-ratings