5-Star Operational Best Practices



Home health agencies are measured on a variety of process and outcome performance measures. CMS reports this performance to patients on the Home Health Compare Website, and encourages patients to choose home health care services based on quality and performance. CMS requires home health agencies to report multiple measures, and summarizes 9 of these into a single ‘star rating’ on quality of patient care. Other purchasers such as insurers and accountable care organizations (ACOs) increasingly use performance measures to guide contracting decisions.


This VNAA Blueprint module examines approaches to improving home health agency operations in order to improve performance on reportable metrics. The recommendations were developed by VNAA’s Operational Best Practice Work Group, and reflect both best available evidence and expert opinion. This module focuses on the strategies to improve performance in 5 categories of measures that align with Home Health Compare, as well as strategies to improve patient experience as capture in Home Health CAHPS. 


VNAA’s recommended operational improvements are categorized into the categories reported in Home Health Compare and used for Star Ratings.  While there are 26 measures reported in Home Health Compare, the 9 measures used in CMS Star Ratings are listed below each category. 

Managing daily activities

  •  Improvement in Ambulation
  •  Improvement in Bed Transferring
  •  Improvement in Bathing

Managing pain and treating symptoms

  •  Improvement in Pain Interfering With Activity
  •  Improvement in Shortness of Breath

Treating wounds and preventing pressure sores

Preventing harm

  •  Timely Initiation of Care
  •  Drug Education on all Medications Provided to Patient/Caregiver
  •  Influenza Immunization Received for Current Flu Season

Preventing unplanned hospital care

  •  Acute Care Hospitalization

Improving patient experience as reported in CAHPS survey (publicly reported January 2016)

  • The star rating reflects performance on composite measures addressing care of patients, communication between providers and patients, and specific care issues.


Because home health agencies often use the same model of quality improvement to tackle different types of improvements, this module first presents an overall model of performance improvement from the Institute for Healthcare Improvement.  Visit the Resources page for other models of quality improvement and links to free online quality improvement training programs. We also examine and recommend Best Practice approaches to other cross-cutting issues that impact performance, including effective use of data, accuracy of OASIS assessments and coding, and effective education and training of staff. 


The VNAA Operational Best Practice Work Group developed Best Practice recommendations for each of the measures driving home health agency Star Ratings, including measures on preventing hospital readmissions. These Best Practice recommendations reflect the expert opinion of leading practitioners and the best available evidence.  VNAA’s best practices are intended to be used in conjunction with an overall quality improvement and compliance program, and adapted as needed for each home health agency. The VNAA Operational Best Practice Work Group approved this website content. VNAA deeply appreciates the active participation and insights of these members.

How to Use These Web Pages:

Start by browsing through the pages of this web-based module to learn more about strategies for improving operations to drive performance improvements. To explore available resources, critical interventions and measurement and evaluation tools, click on the boxes above. You can review or download our 5-Star Operational Best Practices Powerpoint  presentation, or a PDF of all 5-Star Operational Best Practices [coming] web pages. These will be helpful to use in agency trainings or presentations to staff.  Contact VNAA if you have any questions!


This Blueprint module was developed in collaboration with VNAA's Operational Best Practice Work Group. VNAA appreciates the support and expertise provided by Work Group Members.

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