Older is “better” with many Home Health Agencies

Background

Data published by the Centers for Medicare & Medicaid Services (CMS) provides information on 12,261 home health agencies.  Types of services offered by each agency along with certification date is included for all agencies.  The 7,828 agencies (64% of the total) that participated in the Home Health CAHPS© program and received a sufficient number of completed surveys show results on five key measures from that survey along with the total number of surveys completed and the overall response rate among patients contacted.

A summary of Home Health CAHPS results for all reporting agencies nationally

A summary of Home Health CAHPS results for all reporting agencies nationally

Longevity is linked to better results

Whether more experienced agencies have learned to provide better care or attrition weeds out the less effective agencies over time, satisfaction with with home health agencies increases with length of time since the agency was certified.  Agencies in operation for more than 15 years received significantly higher scores on “giving care in a professional way”, “communicating well”, “discussing medicine, pain and home safety” and “overall rating of care.”  Patients are also more likely to say they would “definitely recommend” an agency with more than 15 years experience.

On average, there are no significant differences between agencies with less than 6 years experience (certified in 2010 or later), those with 6 to 10 years experience and those with 11 to 15 years experience on the satisfaction and recommend questions.  However, agencies with 16 to 20 years experience receive significantly higher ratings than those with less than 20 years experience and agencies with more than 20 years experience receive significantly higher scores than those with 16 to 20 years experience.  For example, on the overall rating of care question, the percentage of 9 and 10 responses on the 0-to-10 point scale is shown below by length of time since certification:

  • 85.4% for agencies with 21+ years experience (29% of agencies)
  • 84.4% for agencies with 16 – 20 years experience (21% of agencies)
  • 82.8% for agencies with 11 – 15 years experience (15% of agencies)
  • 82.7% for agencies with 6 – 9 years experience (25% of agencies)
  • 82.3% for agencies with < 6 years experience (9% of agencies)

Survey response rate has even more impact than longevity on results

The total number of surveys completed by an agency is not correlated with level of satisfaction (i.e. having more surveys does not by itself imply better scores), but the percentage of patients who complete an HHCAHPS survey among those that were invited to participate (the “response rate”) is closely linked to satisfaction scores.  Agencies with higher response rates consistently receive higher satisfaction scores and a greater percentage of patients willing to recommend those agencies.  Agencies in operation for 15 or more years do tend to have higher response rates, but even a relatively new agency receive scores comparable to the older agencies when they achieve a high response rate on the survey.

The average response rate is 32.5% across all reporting agencies.  The top 10% of agencies had response rates of 46% or higher while the bottom 10% of agencies had response rates less than 20%.  The overall rating of care question varies by response rate as follows:

  • 79.1% for agencies with <20% response rate (11% of agencies)
  • 81.8% for agencies with 20% – 29% response rate (28% of agencies)
  • 84.7% for agencies with 30% – 39% response rate (37% of agencies)
  • 86.8% for agencies with 40% – 49% response rate (18% of agencies)
  • 88.1% for agencies with 50% or greater response rate (6% of agencies)

 

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