Benchmarking
Benchmarking is the practice of comparing an agency's performance against external reference points such as national or state averages, peer cohorts, or payment-model targets. In home health it spans quality measures, financial indicators, and operational throughput. Under the expanded Home Health Value-Based Purchasing (HHVBP) model, benchmarking is no longer optional analysis: how you compare to your cohort directly determines payment.
What home health agencies benchmark
Useful benchmarking covers three layers of the business:
- Quality: OASIS-based outcome measures, claims-based hospitalization measures, HHCAHPS scores, and star ratings
- Financial: cost per visit, gross margin per episode, days sales outstanding, and denial rates
- Operational: referral-to-SOC conversion, SOC timeliness, documentation turnaround, and clinician productivity
The quality layer is the most standardized because CMS publishes the same measures for every Medicare-certified agency. Financial and operational benchmarks depend more on industry surveys and vendor datasets, so check how each source defines the metric before comparing.
Where benchmark data comes from
Care Compare publishes star ratings and individual quality measures for every agency, which makes competitor comparison straightforward. iQIES agency reports show your OASIS-based outcomes alongside national reference rates. HHVBP performance reports show your measure scores against the achievement thresholds and benchmarks for your cohort, which is the comparison that actually moves payment. For financial and operational metrics, industry association surveys and benchmarking vendors fill the gap, though definitions vary. Whatever the source, note the data period: public quality data lags by several quarters, so pair it with your own current internal numbers.
How HHVBP turned benchmarks into payment
Under the expanded HHVBP model, nationwide since 2023 with the first payment adjustments in CY2025, each agency's measures are scored against an achievement threshold and a benchmark derived from its cohort. Those scores roll up into a Total Performance Score (TPS) that drives a payment adjustment of up to plus or minus 5% of Medicare fee-for-service payments. For CY2026, OASIS-based measures carry 40% of the TPS, claims-based measures 40%, and HHCAHPS 20%. In practical terms, it is not enough to improve against your own history: you have to outperform the comparison group, which makes knowing the benchmark numbers a financial necessity.
What good benchmarking looks like
Effective benchmarking is narrow and repeated, not broad and occasional. Pick a handful of measures where you trail your cohort or your market competitors, assign an owner to each, and recheck quarterly when public data refreshes. Common pitfalls: comparing against national averages when your HHVBP cohort or local competitors are the comparison that matters, celebrating improvement while the benchmark moves faster, and benchmarking metrics nobody is accountable for. The test of a benchmarking program is whether any care process or workflow changed because of it.
Frequently asked questions
What benchmarks does CMS use in HHVBP?
For each measure, CMS sets an achievement threshold and a benchmark based on the performance distribution of agencies in your cohort. Your score on each measure reflects where you fall relative to those points, and the weighted scores roll up into your Total Performance Score, which sets your payment adjustment.
Where can I see how my agency compares to national averages?
Start with Care Compare for publicly reported measures and star ratings, then use iQIES agency reports for OASIS-based outcomes against national reference rates. HHVBP performance reports show your standing against your cohort's thresholds and benchmarks.
How often should an agency benchmark?
Quarterly is the practical cadence, since Care Compare refreshes on a quarterly cycle and HHVBP reports arrive periodically through the year. Internally generated metrics like referral-to-SOC time and cost per visit are worth reviewing monthly because you control the data and can act faster.