Composite score for the Care of Patients Composite = (P1 + P2 + P3 + P4)/4 The score for this composite is produced by combining responses to the four questions below: • Question 9, "In the last 2 months of care, how often did home health providers from this agency seem informed and up-to-date about all the care or treatment you got at home?" • Question 16, "In the last 2 months of care, how often did home health providers from this agency treat you as gently as possible?" • Question 19, "In the last 2 months of care, how often did home health providers from this agency treat you with courtesy and respect?" • Question 24, "In the last 2 months of care, did you have any problems with the care you got through this agency?" Note that the response categories for Questions 9, 16, and 19 are "Never," "Sometimes," "Usually," and "Always" and for Question 24 the response categories are "Yes" and "No." The scoring on this composite will represent the proportion of respondents who responded "Always" to Questions 9, 16, and 19 and "No" to Question 24.

Calculate the proportion (P = X/Y) of cases in the quarter as follows: P1 = Proportion of respondents whose response to Question 9 is Always. P2 = Proportion of respondents whose response to Question 16 is Always. P3 = Proportion of respondents whose response to Question 19 is Always. P4 = Proportion of respondents whose response to Question 24 is No. The proportions P1 through P4 are defined as follows: P = X/Y, where: • The numerator X for each question in the composite is the number of respondents in the quarter who gave the most positive response to each (that is, responded "Always" to Questions 9, 16, and 19 and No to Question 24). • The denominator Y for each question in the composite is the total number of respondents in the quarter who answered the question. Responses of "I only had one provider in the last 2 months of care" in Question 9 should not be included in the denominator of that question's proportion.

The denominator in this equation should include only those questions in the composite that had at least one non-missing response across the home health agency's respondents in the quarter. If a question was completely missing for all respondents in an home health agency in the quarter, then this equation does not include that question.

Patients under 18 years of age at any time during their stay, patients who died during the sample month, patients who received fewer than 2 visits from home health agency personnel during a 60-day look-back period, patients have been previously selected for the HHCAHPS sample during any month in the current quarter, patients who are currently receiving hospice, or are discharged to hospice, maternity only patients, no publicity status patients, and patients receiving only non-skilled (aide) care are excluded.

The patient mix adjustment factors are derived from coefficients obtained from Ordinary Least Squares regression analyses on each separate HHCAHPS response item for the identified patient characteristics. They are calculated directly from these regression coefficients for each HHCAHPS response item by multiplying the coefficients by negative one (−1.0). Patient mix adjustment factors to account for home health agency differences in patient mix are calculated for the latest quarter and applied to home health agency raw scores for each of the latest quarter's HHCAHPS response items. The latest quarter's composite measures are then formed from these adjusted scores. The last four quarters of adjusted scores are then averaged to produce the current quarter's published scores. Published scores are adjusted for differences between an home health agency's patient composition according to the HHCAHPS patient mix characteristics and the overall national composition of home health patients on these same characteristics. Patient mix characteristics: non English survey response, age, education level, residence status (if living alone), self reported health status, mental/emotional status, diagnoses of schizophrenia or dementia/cerebral degeneration.

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The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home Health Care Survey is a standardised survey instrument and data collection methodology for measuring home health patients perspectives on their home health care in Medicare-certified home health care agencies. Home health agencies must contract with an approved HHCAHPS Survey vendor and administer the survey on an ongoing (monthly) basis and submit HHCAHPS Survey data to the HHCAHPS Data Centre on a quarterly basis.

Home Health Quality Reporting (CMS and providers) CMS Care Compare - Home health services and CMS Provider Compare (CMS, providers and publicly reported online). A score for the overall rating is based on survey data from four quarters, computed by averaging the results obtained from each of the four separate quarters.

www.cms.gov/medicare/quality/home-health/home-health-quality-measures homehealthcahps.org/

cmit.cms.gov/cmit/#/MeasureView?variantId=5314&sectionNumber=12 Calculation: homehealthcahps.org/Portals/0/HHCAHPSstepscalculatecomposites.pdf?ver=7PCs8ovwE7U9VewwEbtXVg%3d%3d Risk adjustment: homehealthcahps.org/Portals/0/PublicReporting/PMAandHHCAHPSresultsOctPublicReporting2019.pdf homehealthcahps.org/Portals/0/PublicReporting/LinearizedPatMixCoeffJan2022thruDec2022.pdf