Quality & Outcomes
Reviewed by Zach Newman · Last reviewed July 2026
Quality in home health is public and scored. Care Compare star ratings, HHVBP adjustments, and acute care hospitalization rates all trace back to a set of measures agencies watch closely. This glossary of home health quality measures defines the outcomes language that shapes both reputation and reimbursement, from HHCAHPS and process measures to the Total Performance Score.
24 terms30-Day Readmission
A 30-day readmission is an unplanned return to an acute care hospital within 30 days of an inpatient discharge. Medicare tracks readmissions at both the hospital and post-acute level, and the metric shapes referral relationships, value-based payment adjustments, and public quality reporting. For home health agencies, keeping recently discharged patients out of the hospital is both a clinical responsibility and a growth strategy.
Acute Care Hospitalization Rate
The acute care hospitalization (ACH) rate is the percentage of home health stays during which the patient was admitted to an acute care hospital, historically measured over the first 60 days of home health. It is a claims-based, risk-adjusted measure that served for years as the industry's headline utilization metric before CMS began shifting to the Potentially Preventable Hospitalization measure.
Adverse Event Measures
Adverse event measures are OASIS-derived quality indicators that flag rare, potentially preventable negative outcomes, such as emergent care for an injury caused by a fall or a substantial decline in function during the episode. Unlike publicly reported outcome measures, they are designed as internal warning signals: each flagged case is meant to trigger a chart review, not a rate comparison.
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.
Care Compare
Care Compare is the Medicare.gov website where CMS publicly reports quality data for home health agencies and other provider types. For home health, it displays the Quality of Patient Care Star Rating, the Patient Survey Star Rating, and individual quality measure results drawn from OASIS assessments, Medicare claims, and HHCAHPS surveys.
Claims-Based Measures
Claims-based measures are quality metrics that CMS calculates from Medicare fee-for-service claims rather than from assessments or surveys, requiring no separate data submission by the agency. In home health they capture hospital and emergency department use, discharge to community, and spending efficiency, and they carry 40% of the HHVBP Total Performance Score in the CY2026 measure set.
Discharged to Community (DTC)
Discharged to Community (DTC) is a claims-based quality measure assessing whether home health patients were discharged to the community and remained there safely, without an unplanned hospital admission or death in the 31 days following discharge. The post-acute care version, DTC-PAC, is used in home health public reporting and joined the expanded HHVBP measure set with the CY2025 performance year.
Emergency Department Use Without Hospitalization
Emergency department (ED) use without hospitalization is a claims-based home health quality measure counting the percentage of home health stays during which the patient visited an ED but was not admitted to the hospital. It flags episodes where patients sought emergency care that a well-functioning home health plan might have prevented or handled in the home.
HHCAHPS
HHCAHPS (Home Health Care Consumer Assessment of Healthcare Providers and Systems) is the standardized CMS survey that measures patients' experience of care from Medicare-certified home health agencies. Administered by approved third-party vendors, its results are publicly reported on Care Compare and feed both the Patient Survey Star Rating and the Home Health Value-Based Purchasing model.
HHVBP (Home Health Value-Based Purchasing)
Home Health Value-Based Purchasing (HHVBP) is a CMS model that adjusts Medicare fee-for-service payments to home health agencies based on quality performance, with adjustments of up to plus or minus 5%. The expanded model has applied to all Medicare-certified home health agencies nationwide since January 2023, and the first payment adjustments took effect in CY2025.
Improvement in Ambulation
Improvement in ambulation is an OASIS-based home health outcome measure showing the percentage of quality episodes in which a patient's ability to walk or move safely improved between the start or resumption of care assessment and discharge. It is risk-adjusted, publicly reported, and feeds the Quality of Patient Care Star Rating on Care Compare.
Improvement in Dyspnea
Improvement in dyspnea is an OASIS-based home health outcome measure showing the percentage of quality episodes in which a patient became less short of breath between the start or resumption of care assessment and discharge. It is risk-adjusted and has long featured in home health public reporting and quality programs as the leading respiratory outcome.
Improvement in Self-Care
Improvement in self-care refers to the family of OASIS-based home health outcome measures tracking whether patients gained independence in activities of daily living, such as bathing, dressing, and managing oral medications, between the start or resumption of care and discharge. Self-care outcomes gained weight in the expanded HHVBP model, whose CY2026 measure set adds new bathing and dressing function measures to the OASIS-based category.
OBQI (Outcome-Based Quality Improvement)
OBQI (Outcome-Based Quality Improvement) is a CMS framework in which home health agencies use risk-adjusted, OASIS-based outcome reports to identify weak outcomes, investigate the care processes behind them, and implement a targeted plan of action. It pairs with OBQM (Outcome-Based Quality Monitoring), which tracks adverse events, and its logic underpins modern QAPI programs and value-based purchasing preparation.
Outcome Measures
Outcome measures capture how a patient's health status changed over the course of home health care, typically between start of care and discharge. In home health they are calculated from OASIS assessments or Medicare claims, risk-adjusted for patient characteristics, and used in public reporting on Care Compare, star ratings, and the Home Health Value-Based Purchasing model.
Patient Safety Events
Patient safety events are incidents during care that result in harm to a patient or create a meaningful risk of harm, such as falls with injury, medication errors, pressure injuries, and infections. In home health, these events happen in an uncontrolled environment the agency visits intermittently, which makes systematic identification, reporting, and follow-up harder and more important than in facility settings.
Patient Survey Star Rating
The Patient Survey Star Rating is a 1 to 5 star score on Care Compare that summarizes a home health agency's performance on the HHCAHPS patient experience survey. CMS publishes star ratings for key survey measures plus a summary rating, giving referral sources and families a quick read on how patients rate the agency's care.
Potentially Preventable Hospitalization
Potentially Preventable Hospitalization (PPH) is a claims-based, risk-adjusted home health quality measure that counts inpatient admissions and observation stays occurring during a home health stay that are classified as potentially preventable. It replaced the all-cause acute care hospitalization and emergency department use measures in CMS home health quality programs, including the expanded HHVBP model beginning with the CY2025 performance year.
Process Measures
Process measures assess whether a home health agency performed specific evidence-based care practices, regardless of how the patient's condition ultimately changed. The flagship example in home health is Timely Initiation of Care, which measures whether care started within the required window after referral or hospital discharge.
Public Reporting
Public reporting is the CMS practice of publishing home health agency quality data for anyone to see, primarily through the Care Compare website. Published data includes star ratings, OASIS-based outcome measures, claims-based measures, and HHCAHPS patient survey results. Because referral sources, health systems, and patients all consult this data, public reporting turns quality performance into a marketing asset or a liability.
Quality of Patient Care Star Rating
The Quality of Patient Care Star Rating is a 1 to 5 star summary score, in half-star increments, that CMS publishes for each home health agency on Care Compare. It condenses a defined set of OASIS-based and claims-based quality measures into a single consumer-facing rating, updated quarterly.
Rehospitalization Reduction
Rehospitalization reduction is the systematic effort to keep home health patients from returning to the hospital during or shortly after their episode of care. It sits at the center of home health quality strategy because hospitalization outcomes drive HHVBP payment adjustments, star ratings, and the referral decisions of hospitals, ACOs, and Medicare Advantage plans.
Timely Initiation of Care
Timely initiation of care is a home health process measure showing the percentage of episodes in which care began within two days of the referral date, the physician-ordered start date, or the patient's inpatient facility discharge. It is publicly reported on Care Compare and is a component of the Quality of Patient Care Star Rating.
Total Performance Score (TPS)
The Total Performance Score (TPS) is the composite score, on a 0 to 100 scale, that CMS calculates for each home health agency under the expanded Home Health Value-Based Purchasing (HHVBP) model. It combines weighted OASIS-based, claims-based, and HHCAHPS survey measures, and it directly determines the agency's Medicare payment adjustment of up to plus or minus 5%.
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