CHARLOTTE 鈥� Home health agencies are a segment of the medical industry that you may not know about if you or a loved one has never needed one. The companies send therapists and nurses into the homes of Medicare patients to help them recover from an illness or surgery.
This summer the federal government started rating home health agencies 鈥� doling out one to five stars 鈥� to give consumers a better picture of the job 聽they do. The : only 239 agencies out of 9,000 nationwide earned five stars, according to a Kaiser Health News analysis.
In North Carolina, Brookdale Home Health Charlotte was one of just two agencies out of more than 170 in the state to earn five stars. How did they manage it?
Physical therapist Kurt Harcar鈥檚 session with Annie Wilson is a window into聽Brookdale鈥檚 success.
Harcar helped Wilson to her feet and handed her a soccer ball. 鈥淵ou鈥檙e going to hold onto the ball, both hands,鈥� he said. 鈥淣ow we want to go side to side.鈥�
鈥淚 was a great square dancer back in my young days,鈥� Wilson, 105, said with a laugh.
It鈥檚 far from square dancing, but the exercise is designed to improve her balance and help her manage the walker that allows her to still get around on her own.
鈥淭he big key that we try and focus on here is making sure they鈥檙e safe and as independent as they can be,鈥� Harcar聽said. The side-to-side soccer ball move can help Wilson maintain her balance as she navigates the kitchen or bathroom in her apartment.
How often patients get better at moving around is one way Brookdale sets itself apart. It鈥檚 also far above national averages on quickly initiating care and easing pain, .
鈥淭hese metrics as a whole show home health鈥檚 ability to improve somebody鈥檚 function and home health鈥檚 ability to prevent costly episodes that are negative for the patient, like a hospitalization or like a delay in service,鈥� said Harrison Brown of , a consulting firm.
That鈥檚 part of the reason Medicare is putting a brighter spotlight on home health 鈥� by keeping people out of the hospital, it can save the federal government money.
Brown said the new star ratings are good for consumers and for the most effective agencies.
鈥淭his is really an opportunity for home health agencies to differentiate themselves, given that home health actually has a lot of variability in it in terms of quality and cost,鈥� Brown said.
The ratings have limitations. Bill Dombi of the National Association for Home Care and Hospice says that for one, they emphasize improvement.
鈥淭he population in home health tends to be fairly aged with multiple chronic illnesses, where stabilization may be the goal rather than improvement,鈥� he said.
Dombi said it鈥檚 unrealistic for a patient with Parkinson鈥檚 disease, for example, to get much better. But home health can help that person maintain some independence.
Another limitation is that the underlying data for the star ratings are self-reported, which creates potential for some agencies to pad their stats.
鈥淵ou don鈥檛 know what you鈥檙e getting, and there is little quality oversight of the data,鈥� said Dan Mendelson, CEO of consulting firm Avalere Health.
He said the data need to improve before Medicare starts tying payments to the quality metrics, as it鈥檚 already doing with hospitals.
鈥淪ome home health agencies are taking this very seriously and are getting really good real-time data and going in and collecting the data on patients that they see, and others aren鈥檛,鈥� he says. 鈥淭hat鈥檚 the situation right now.鈥�
Brookdale Home Health Charlotte is getting real-time data. Nurses like Ginny Grenda use tablets to update patient information as they go.
鈥淚 don鈥檛 hear near as much congestion as I did when we were listening last week,鈥� she told patient Larry Goelz as she listened to his lungs recently.
Goelz is coming off a hospitalization for pneumonia and congestive heart failure. To help his lungs recover, she鈥檚 given him a device he can use to practice blowing.
It鈥檚 easy for Grenda to keep tabs on Goelz 鈥� she鈥檚 part of 聽a Brookdale team聽 set up inside this retirement community. 鈥淲e are in the building, which helps,鈥� she says. 鈥淲e see them intermittently. But if there is a complication, the staff can get us, and we can get orders to see the patient as needed.鈥�
Brookdale Home Health has teams set up in 22 retirement communities in the Charlotte area. That may give it an advantage in the star ratings over agencies that are constantly driving from home to home.
That said, the only other five-star agency in North Carolina, Well Care Home Health in Wilmington, mostly does serve private homes.
Brookdale鈥檚 director, Cheryl Engram, says the more important factors are how experienced her staff is and how well they know their patients. One nurse said she is as familiar with her patients as she is with her family.
鈥淭hat speaks to me volumes about what we do and the services that we provide,鈥� Engram says. 鈥淣ot just the fact that we鈥檝e got a team of people here, but that the people who make up that team are following through on the things that they need to do.鈥�
Engram says Brookdale is now looking to expand, and it鈥檒l use its five-star rating as a selling point.
This story is part of a partnership that includes , and Kaiser Health News.