You're being discharged from the hospital. A social worker hands you a list of home health agencies. You pick one. Care starts in 48 hours.
What you probably don't know: CMS has already rated every agency on that list. Some have 5 stars. Some have 1 star. The social worker is not required to tell you which is which.
What CMS Actually Measures
The Quality of Patient Care star rating is calculated from a set of outcome measures that track what happens to patients during home health episodes. This is not a survey. It is not self-reported. It is based on clinical data that agencies are required to submit to CMS through a standardized assessment instrument called OASIS.
The measures include:
- Functional improvement — Did the patient get better at walking, bathing, getting in and out of bed, managing medications, and breathing?
- Hospitalization rate — How often did the agency's patients end up back in the hospital?
- Emergency room use — How often did patients need urgent, unplanned ER visits?
- Timely initiation of care — Did the agency start care when it was supposed to?
These are not subjective opinions. They are measured outcomes reported on a standardized federal form.
The Two Star Ratings
CMS publishes two separate star ratings for each agency:
Quality of Patient Care (1-5 stars): Based on the clinical outcome measures listed above. This tells you how well the agency actually performs — whether patients improve under their care.
Patient Survey Rating (1-5 stars): Based on the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey. Former patients are asked about their experience — whether staff communicated well, whether care was delivered on time, whether they would recommend the agency.
Both ratings matter, but they measure different things. An agency can have great bedside manner and poor clinical outcomes, or excellent outcomes with lower patient satisfaction. The quality rating tells you what happened to patients clinically. The patient survey tells you how patients felt about the experience.
Why Most Patients End Up With a Lower-Rated Agency Than the Best Option Near Them
Our analysis of CMS Home Health Compare data finds that in most US service areas, the majority of Medicare patients receive care from agencies that are not the highest-rated option available in their area. This is not because the data doesn't exist. CMS publishes quality ratings quarterly and the data is free.
The problem is the referral pipeline. Hospital discharge planners hand patients a list. The list is not ranked by quality. It's shaped by relationships, contracts, and in many cases, the agencies that are most responsive to the hospital's referral coordinator — not the agencies that deliver the best patient outcomes.
Existing home health directories compound the problem. Most are paid by the agencies they list. When you search for home health on a referral platform, the results are influenced by who pays for placement — not by who CMS rates highest.
(Analysis based on CMS Home Health Compare data. See our methodology page for how this finding is derived.)
What You Should Actually Do
Step 1: Look up the star rating before you say yes.
When a discharge planner gives you a list, don't just pick the first name. Look up each agency's CMS quality rating. A 2-star difference in quality rating can mean the difference between a patient who improves and one who ends up back in the hospital.
Step 2: Compare hospitalization rates.
This is the most important number most families never see. Some agencies in the same city have hospitalization rates 3x higher than others. If an agency's patients are frequently ending up back in the hospital, that tells you something concrete about their care quality.
Step 3: Check patient survey scores.
After clinical outcomes, look at the CAHPS patient survey. Did former patients feel the agency communicated well? Would they recommend it? These scores come from actual patients, not from the agency's marketing department.
Step 4: Ask the discharge planner why they recommended this specific agency.
A good discharge planner will be able to tell you. If they can't explain why one agency is better than another for your specific situation, they may be working from a referral relationship rather than quality data.
CMS publishes this data for a reason. Use it. Compare agencies near you