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.
What process measures capture
A process measure asks a yes-or-no question about care delivery: did the agency do the expected thing for the patients who should get it? Because the agency controls the action being measured, process measures are minimally risk-adjusted and are considered fully within the agency's power to improve. That makes them the fastest measures to move, and also the least forgivable to score poorly on. A weak outcome score invites explanation; a weak process score reads as an operations problem, because it usually is.
Timely Initiation of Care: the one everyone watches
Timely Initiation of Care, the most prominent home health process measure, calculates 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 discharge. It is publicly reported on Care Compare and factors into the Quality of Patient Care Star Rating. It is also the process measure referral sources care about most, since a hospital discharge planner's own readmission exposure is highest in the first days after discharge. An agency that reliably starts care fast has a concrete, provable selling point; one that does not will hear about it in referral volume before it sees it in a report.
How process measures fit the quality landscape
CMS has trimmed process measures over the years as the quality programs shifted weight toward outcomes, retiring measures that showed uniformly high performance and offered little differentiation. What remains in public reporting and value-based purchasing is mostly outcome-oriented, with process measures serving as leading indicators. Internally, though, agencies still track many process metrics that never appear on Care Compare, such as OASIS submission timeliness, order turnaround, and supervisory visit compliance, because they predict downstream outcome and compliance failures.
What good process performance looks like
- Intake triages referrals same-day and confirms the physician-ordered start date in writing
- Scheduling has weekend and evening capacity so Friday referrals do not become Monday starts
- Missed and declined first visits are escalated the same day, with documentation of patient-driven delays
- Process metrics are reviewed weekly at the branch level, not quarterly at the corporate level
- Every process failure gets traced to a step owner, since process measures fail at handoffs
Frequently asked questions
What is the difference between a process measure and an outcome measure?
A process measure checks whether the agency performed a defined care practice, such as starting care within two days. An outcome measure checks what happened to the patient, such as improved ambulation or avoiding hospitalization. Process measures are more directly controllable; outcome measures carry more weight in payment programs.
Are process measures risk-adjusted?
Generally no, or only minimally. Because the measured action is within the agency's control, CMS expects comparable performance regardless of patient mix, which is part of why poor process scores are hard to defend.
Which process measure affects star ratings?
Timely Initiation of Care is the key process measure feeding the Quality of Patient Care Star Rating, alongside OASIS-based and claims-based outcome measures. Improving it typically requires intake and scheduling changes rather than clinical practice changes.