Home Health Agencies with High Quality of Patient Care Star Ratings Reduced Short-Term Hospitalization Rates and Increased Days Independently at Home

Background: Critics argue that Medicare's Quality of Patient Care home health star ratings are inaccurate. Valid ratings are essential to help patients find high-quality care. Objective: The aim of this study was to determine whether using the highest-rated home health agency available in a ZIP code improves outcomes. Research Design: A retrospective study of 1,870,080 Medicare fee-for-service beneficiaries using home health care from July 2015 through July 2016 in the United States. An instrumental variables approach is used to address the endogeneity of agency choice, where the instrument is the differential proximity of the patient to the closest highest-rated and closest lower-rated agency. Outcomes: Days independently at home; health care setting-specific days and death; hospitalization, emergency department use, and institutionalization risk. Results: Treatment by the highest-rated agencies available decreased risks (in percentage points) of hospitalization (-3.2; 95% CI, -4.1 to -2.3), emergency department use (-2.2; 95% CI, -3.2 to -1.1), and institutionalization (-0.9; 95% CI, -1.3 to -0.5) during the initial episode, and increased days independently at home by 2.6% or 3.75 (95% CI, 2.20-5.29) days in the 180 days after the end of the initial episode. Treatment effects were more pronounced for agencies that were above-average (6.51 d; 95% CI, 4.15-8.87), had ≥1 more star than the next-best agency (7.80 d; 95% CI, 4.13-11.47), and nonrural residents (4.57 d; 95% CI, 2.75-6.40). Effects were positive for both postacute (3.40; 95% CI, 1.80-5.00) and community-entry (5.60; 95% CI, 2.30-8.89) patients. Conclusions: Medicare's Quality of Patient Care star rating correlates with reduced short-term hospitalizations and emergency department use and increased days independently at home in the longer term.