Communications between Providers and Patients Composite = (P1 + P2 + P3 + P4 + P5 + P6)/6 The score for this composite is produced by combining responses to the six questions below. • Question 2, "When you first started getting home health care from this agency, did someone from the agency tell you what care and services you would get?" • Question 15, "In the last 2 months of care, how often did home health providers from this agency keep you informed about when they would arrive at your home?" • Question 17, "In the last 2 months of care, how often did home health providers from this agency explain things in a way that was easy to understand?" • Question 18, "In the last 2 months of care, how often did home health providers from this agency listen carefully to you?" • Question 22, "In the last 2 months of care, when you contacted this agency's office did you get the help or advice you needed?" • Question 23: When you contacted this agency's office, how long did it take for you to get the help or advice you needed?" Note that the response categories for Questions 2 and 22 are "Yes" and "No." The response categories for Questions 15, 17, and 18 are "Never," "Sometimes," "Usually," and "Always." The response categories for Question 23 are "Same day," "1 to 5 days," "6 to 14 days," and "More than 14 days." The scoring on this composite will represent the proportion of respondents who answered"Yes" to Questions 2 and 22, "Always" to Questions 15, 17, and 18, and "Same day" to Question 23.

Calculate the proportion (P = X/Y) of cases in the quarter as follows: P1 = Proportion of respondents whose response to Question 2 is "Yes." P2 = Proportion of respondents whose response to Question 15 is "Always." P3 = Proportion of respondents whose response to Question 17 is "Always." P4 = Proportion of respondents whose response to Question 18 is said "Always." P5 = Proportion of respondents whose response to Question 22 is "Yes." P6 = Proportion of respondents whose response to Question 23 is "Same day." The proportions for P1 through P6 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 question (that is, responded "Yes" to Questions 2 and 22, "Always" to Questions 15, 17 and 18, and "Same day" for Question 23). • The denominator Y for each question in the composite is the total number of respondents in the quarter who answered the question. Responses of "Do not remember" in Question 2 and "I did not contact this agency" in Questions 22 and 23 should not be included in the denominators of those respective proportions.

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