OHD Learn · Provider Type Guide

Home Health Agencies

Deliver skilled clinical care in the patient's home — nursing, therapy, and rehabilitation without the hospital stay.

What Is Home Health Care

Skilled clinical care that comes to the patient.

A Medicare-certified home health agency sends licensed clinicians directly to the patient, wherever they live, to provide medical treatment. This is not personal care or household assistance — it is skilled nursing, physical therapy, occupational therapy, speech pathology, and medical social services, ordered by a physician and billed to Medicare under a defined episode of care.

The patients served span a wide range of clinical situations. A patient recovering from a hip replacement who needs physical therapy. A patient recently discharged from the hospital after a stroke who requires daily nursing visits. A person with a complex chronic condition — heart failure, diabetes, COPD — whose disease management requires regular skilled assessment that cannot wait for an office visit. What these patients share is a physician-documented need for skilled care and a homebound status that qualifies them for the Medicare benefit.1

Medicare pays for home health in 30-day episodes.2 The agency is responsible for coordinating all covered services during that window — which is why the data places significant weight on what happens when care ends, not just whether individual visits go well.

What the Data Covers

Three programs measure outcomes, experience, and payment.

The data comes from three separate programs, each designed to answer a different question: did patients get better clinically, did they say their care was good, and how did performance affect what the agency was paid? All three are reflected in what OpenHealthData surfaces.

📋
Home Health Quality Reporting Program (HHQRP)
The HHQRP is the primary federal quality program for home health agencies. It produces two distinct types of measures that work differently and draw from different data sources — but both fall under the same reporting umbrella.
OASIS Outcome Measures
The Outcome and Assessment Information Set is completed by the clinician at the start and end of every Medicare episode. It captures the patient's functional and clinical status at both points — the difference between those two assessments drives most of the quality measures. These are the metrics that tell you whether patients actually improved under this agency's care.
  • Improved mobility — walking, transferring, bathing
  • Improved breathing (dyspnea)
  • Improved medication management
  • Discharge function score — ability to care for self at discharge
  • Falls with major injury
  • New or worsening pressure injuries
  • Flu vaccination status assessed
  • COVID-19 vaccine status
  • Timely start of care
Claims-Based Outcome Measures
Where OASIS measures what the clinician recorded, claims-based measures look at what happened in the broader healthcare system afterward. These track hospitalizations and readmissions observable in Medicare billing data — regardless of what the agency reported. All are risk-standardized, comparing each agency's actual rate to what would be expected for their specific patient mix.
  • Discharge to community — share of patients who returned home rather than to an institution
  • Potentially preventable readmissions within 30 days of discharge
  • Potentially preventable hospitalizations during the episode itself
  • Risk-standardized rates with confidence intervals
  • Performance category — better, same, or worse than national rate
Medicare Spending
CMS also publishes what Medicare spends per episode of care at each agency, benchmarked against the national average. A score above 1.0 means this agency costs more than average for comparable patients; below 1.0 means it costs less.
  • Medicare spending per beneficiary — ratio to national average
  • Number of episodes used in calculation
🗣️
HHCAHPS Patient Survey
The Home Health Consumer Assessment of Healthcare Providers and Systems survey collects patient-reported experience directly — separate from any clinical assessment. Patients are asked whether their care team was professional, communicated clearly, discussed medications and home safety, and whether they would recommend the agency. Results are summarized as star ratings and percentage scores, and are published on Medicare.gov independently from the clinical outcome measures.
  • Professional care — star rating and percent
  • Communication between team and patient — star rating and percent
  • Medicines, pain, and home safety discussion
  • Overall rating of care (0–10 scale)
  • Willingness to recommend the agency
  • Survey response rate and number of completed surveys
⚖️
Home Health Value-Based Purchasing (HHVBP)
Home health is one of the few provider settings where CMS directly ties quality performance to Medicare payment rates. Agencies receive a Total Performance Score based on a combination of OASIS, CAHPS, and claims-based measures — and that score adjusts their Medicare reimbursement by as much as ±5% annually. Agencies are grouped into two nationwide cohorts by volume and scored relative to peers.
  • Per-measure achievement points and improvement points
  • Total Performance Score (TPS)
  • Adjusted Payment Percentage (APP) — final ±5% adjustment
  • Cohort assignment — larger or smaller volume
About the Data

Where the data comes from and how often it is updated.

All home health quality data is published by the Centers for Medicare and Medicaid Services as part of the Home Health Quality Reporting Program. Medicare-certified agencies are required to submit OASIS assessments for all patients — making the clinical outcome measures broadly representative of what each agency actually delivers. The HHCAHPS patient survey is separately administered, and agencies must meet minimum thresholds for completed surveys before results are reported publicly.

The OASIS-based and CAHPS measures are refreshed quarterly, each reflecting a rolling 12-month collection window. The claims-based measures — discharge to community, readmissions, and hospitalizations — are based on 24 to 36 months of data depending on the measure and are refreshed annually. The VBP performance data is published once per performance year. This means different measures on the same agency profile may reflect different time periods — a feature of how CMS staggers data collection, not a gap in the underlying data.

Over 12,000 home health agencies are currently active in the Medicare program. Coverage, service mix — including whether an agency offers nursing, physical therapy, occupational therapy, speech pathology, or home health aide services — and performance vary significantly across agencies, even within the same market.

Sources
  1. 42 C.F.R. § 409.42 — homebound status criteria for Medicare home health eligibility. See also CMS Home Health PPS
  2. CMS Patient-Driven Groupings Model (PDGM), effective January 1, 2020 — transitioned Medicare home health payment from 60-day to 30-day episodes. See CMS PDGM overview
  3. CMS Home Health Quality Reporting Program — Home Health Quality Measures
  4. CMS Provider Data Catalog — Home Health Services datasets
  5. HHQRP and HHVBP Data Dictionary, Version 13.0, January 2026 — CMS Provider Data Catalog