When CMS rates home health agencies, it publishes two separate star ratings. The first — Quality of Patient Care — measures clinical outcomes. The second — the Patient Survey Rating — measures something different: what patients actually thought about their experience.
That second rating comes from CAHPS.
What CAHPS Is
CAHPS stands for Consumer Assessment of Healthcare Providers and Systems. It is a standardized survey instrument developed by the Agency for Healthcare Research and Quality (AHRQ) and used across many healthcare settings — hospitals, health plans, nursing homes, and home health agencies.
For home health, CMS contracts with approved survey vendors to contact a random sample of patients after they've been discharged from home health care. The survey is conducted by mail, with phone follow-up for non-respondents. Agencies cannot choose which patients get surveyed.
This matters because it means the results are not cherry-picked testimonials. They come from a random, representative sample of actual patients, collected by independent survey firms.
What the Survey Asks
The CAHPS Home Health Survey covers several domains:
Care of Patients: How well did the home health team provide care? Did they seem informed? Did they work together as a team?
Communication: How well did home health providers communicate with patients? Did they explain things clearly? Did they listen carefully? Did they treat the patient with courtesy and respect?
Specific Care Issues: Did the home health team discuss medications, pain, and the home environment? Did they address safety concerns?
Overall Rating: On a 0-10 scale, how would patients rate their home health care? CMS reports the percentage who gave a 9 or 10.
Willingness to Recommend: Would patients recommend the home health agency to friends and family?
How Star Ratings Are Calculated
CMS converts the CAHPS survey results into a 1-5 star rating. The calculation adjusts for patient mix — because some agencies serve sicker or more complex patients — so the comparison is as fair as possible.
The star rating is published separately from the Quality of Patient Care rating. An agency can have 5 stars for clinical outcomes and 3 stars for patient experience, or vice versa.
What the Scores Tell You (and What They Don't)
CAHPS scores tell you whether patients felt respected, informed, and well-communicated with. These are real indicators of care quality that clinical outcome measures alone don't capture.
But patient experience and clinical outcomes don't always align. An agency might have excellent bedside manner but mediocre clinical results. Another agency might deliver outstanding functional improvement with staff who aren't as warm.
The best agencies score well on both. When you're comparing agencies, look at both ratings. If you have to prioritize, the Quality of Patient Care rating is more directly tied to your physical recovery. But communication quality matters too — especially for patients managing complex conditions where understanding your treatment plan affects your outcomes.
Why Response Rates Matter
One limitation of CAHPS data: not all agencies have enough survey responses to generate a reliable star rating. CMS requires a minimum number of completed surveys. Smaller agencies or newer agencies may show "Not enough data" instead of a star rating.
This doesn't mean the agency is bad. It means there isn't enough survey data to rate them. In these cases, lean more heavily on the Quality of Patient Care rating, which is calculated from clinical data that every agency submits regardless of size.
Compare patient satisfaction scores for agencies in your area