The Triangle’s home health agencies received passing grades under Medicare’s new 5-point grading system designed to root out pervasive fraud in an industry that plays an increasing role in caring for the nation’s elderly.
The grading system assesses the responsiveness and thoroughness of nurses, aides and therapists who make house calls to the elderly to provide care. The home health agency approach is one of the least expensive ways to provide skilled services that require a doctor’s authorization and are covered by Medicare.
Because home visits are conducted in private and without supervision, they are prone to fraud. A federal investigation found that in 2010, of the $19.5 billion Medicare paid to home health agencies, $5 million was paid in error, including “billing for services on dates after beneficiaries’ deaths.”
The grades, released Thursday, show that 17 agencies in the Triangle received scores ranging from 2.5 to 4.5. A score of 3 is considered acceptable and lower scores are considered below average.
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The Triangle’s highest score was 4.5 stars and was awarded to two Raleigh agencies: Well Care Home Health and Bayada Nurses.
Of 172 agencies in North Carolina, only two received perfect scores of 5 – Well Care Home Health in Wilmington and Brookdale Home Health in Charlotte – while nine agencies received scores of 2 points, the lowest in the state.
Nationwide, of 12,261 agencies rated, six received low scores of 1 and 195 were barely above the bottom at 1.5 points. Most agencies statewide and nationwide ranked in the middle range.
Likewise in North Carolina, more than half of all agencies – 53 percent – receives scores of 3 and 3.5. But only 18 percent received scores of 4 and 4.5, while 28 percent got 2 or 2.5.
The scores come from claims data and are self-reported to Medicare by the home health agencies. The ratings reflect performance from the fall of 2013 through the end of 2014.
To receive a star rating, a home health agency must be certified for at least 6 months and must have reported data on at least five of the nine quality measures in the Quality of Patient Care Star Rating system.
An analysis by the independent Kaiser Health News found that the highest scores went to visiting nurse associations and agencies with religious affiliations. The lowest scores tended to go to agencies run out of skilled nursing homes and agencies associated with local governments.
Last year, 3.4 million Medicare beneficiaries received home health services as part of the $18 billion annual program, KHN reported.
The star ratings are based on nine quality-of-care measures, including whether the visiting aide cared for the patient in a timely manner, whether the aide taught patients about their drugs, and whether the aide administered a flu shot and pneumonia shot.
Other measures included checking patients for risk of falling, for depression, for pain as well as providing foot care and taking action to prevent bed sores.