Care Compare Home Health: How to Use CMS Star Ratings to Choose an Agency
The hospital discharge planner just gave you three home health agency names and told you to pick one by tomorrow morning. You have no idea how to evaluate them, and the planner won't recommend one over another. CMS Care Compare — the federal government's provider comparison tool — is the closest thing to an objective scorecard, but reading it correctly takes some context the site doesn't provide.
What Care Compare Actually Measures
Care Compare assigns home health agencies two types of star ratings, each based on different data:
Quality of Patient Care stars measure clinical outcomes — how often patients improved in walking, getting in and out of bed, bathing, breathing, and wound healing. These ratings also track negative outcomes like unplanned hospitalizations and emergency room visits. Higher stars mean the agency's patients had better measurable outcomes compared to national benchmarks.
Patient Survey stars come from the HHCAHPS survey, which asks patients and caregivers about their experience: whether the agency communicated well, responded to requests promptly, explained medications clearly, and treated them respectfully. The April 2026 survey revision added questions on topics patients identified as important while reducing medication management questions from six to two.
Patient Survey stars include an overall rating-of-care measure based on HHCAHPS responses. Agencies with too few survey responses may not receive a Patient Survey star rating, even though other Care Compare data may still be displayed.
How to Read the Ratings Critically
A few things the star display doesn't make obvious:
Three stars is average, not bad. The ratings are designed so the national distribution centers on three stars. An agency with three stars is performing at the national median. Four and five stars indicate meaningfully above-average performance.
Check the date. CMS refreshes Care Compare data periodically — typically quarterly. If you're choosing an agency in August, the displayed data may reflect performance from months earlier. Significant quality changes (staffing turnover, new management, ownership changes) won't show up immediately.
Look at the component scores, not just overall. An agency might score five stars on quality (great clinical outcomes) and two stars on patient experience (poor communication, scheduling problems). If your parent has complex medical needs, the quality score matters more. If your parent is cognitively intact and values dignity and communication, the patient survey score matters more.
Small agencies have more volatile ratings. An agency serving 30 patients can swing a full star based on a handful of outcomes. Larger agencies with hundreds of patients produce more stable, statistically meaningful ratings.
What Care Compare Doesn't Tell You
The ratings measure outcomes and satisfaction, but they don't capture everything families care about:
- Staffing consistency. Will the same nurse and aide visit your parent each week, or will the agency rotate staff constantly? Care Compare doesn't track this, but consistency dramatically affects quality of care for patients with dementia or complex routines.
- Response time. How quickly does the agency start care after the referral? Some agencies begin within 24 hours; others take a week to schedule the initial assessment.
- Specialty programs. Does the agency have dedicated wound care nurses, cardiac rehabilitation protocols, or dementia-trained aides? These specializations don't appear in the star ratings.
- Geographic coverage. Rural families may find that the highest-rated agency serves a limited radius and won't drive to their parent's address.
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A Practical Selection Process
Start on Care Compare, but don't stop there:
- Search by zip code at medicare.gov/care-compare to pull all certified agencies serving your parent's area
- Filter for agencies with at least three Quality of Patient Care stars as an initial screen — this eliminates the bottom performers
- Among the remaining agencies, call each one and ask: average time from referral to first visit, whether they assign consistent staff, whether they have experience with your parent's condition, and whether they accept your parent's insurance (original Medicare or their specific MA plan)
- Ask the discharge planner which agencies have the smoothest referral process with the hospital — coordination matters during transitions
The Medicare Home Health and Skilled Nursing Benefit guide includes a full agency evaluation checklist with the questions to ask each agency and a side-by-side comparison worksheet.
Get Your Free The Medicare Home Health and Skilled Nursing Benefit — Quick-Start Checklist
Download the The Medicare Home Health and Skilled Nursing Benefit — Quick-Start Checklist — a printable guide with checklists, scripts, and action plans you can start using today.