CMS star ratings explained: How they work and how to use them when evaluating care

Choosing a home health agency for a loved one is one of the most important decisions a family can make. When searching online, star ratings often appear beside agency names, but without context, those numbers can be difficult to interpret. These ratings come from the Centers for Medicare & Medicaid Services (CMS) and knowing how to read them can make the search clearer and help families feel more confident.

What are CMS star ratings?

CMS star ratings are a measurement system that ranks Medicare-certified providers and facilities on a scale of 1 to 5 stars. These ratings are published on CMS Care Compare, a free tool at Medicare.gov that lets caregivers search for and compare home health agencies and other providers side by side. Higher star ratings reflect stronger performance in quality of care and patient experience, based on consistent, objective data across eight provider categories:

• Doctors and clinicians
• Hospitals
• Nursing homes
• Home health services
• Hospice care
• Inpatient rehabilitation facilities
• Long-term care hospitals
• Dialysis facilities

How CMS star ratings work for home health agencies

On Care Compare, home health agencies receive two separate CMS star ratings that help caregivers evaluate quality before choosing a provider. The first measures clinical outcomes and care processes. The second measures the patient experience of care. Together, they offer a more complete view of agency performance than either rating alone.

The Quality of Patient Care Star Rating is based on clinical outcomes and process measures collected from patient assessments. It reflects how patients progress during their care, including:

• Timely start of care
• Improvement in walking and mobility within the home
• Progress with transfers in and out of bed
• Improvement in bathing and personal care
• Adherence to prescribed oral medications
• Improvement in respiratory status
• Prevention of avoidable hospitalizations during the home health stay

CMS updates this rating quarterly so that the information reflects recent performance. The Patient Survey Star Rating comes directly from patients and their families through a standardized survey called the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS).

It reflects how well the care team communicated, how professional and responsive staff were, and how patients felt about their overall experience. An agency must have at least 40 completed surveys in the reporting period to receive this rating.

These two ratings together give a more complete picture of an agency’s performance: one grounded in clinical outcomes and one grounded in the voices of the people who received care.

How to interpret ratings and use Care Compare to choose a home health agency

CMS star ratings are a helpful starting point, but they are not the whole picture. A rating of 3 stars means an agency performed at the national average. A rating above 3 means performance was above average on those specific measures. A rating below 3 means performance was below average, though CMS notes this does not necessarily mean care is poor. Ratings are also relative — not every community will have a 4- or 5-star agency, but that can change over time for a variety of reasons.

Understanding how home health agencies are rated helps families compare options more confidently. Care Compare gives families one place to search for and compare home health agencies, viewing Medicare home health ratings alongside details about the services each agency provides — such as the specific conditions treated, the types of therapy offered and the geographic area served.

CMS encourages families to look at both ratings together, consider the specific services a loved one needs, ask agencies directly about their approach to care and discuss home health quality with a physician. Home healthcare quality ratings are just a starting point for that conversation — but visiting with an agency directly, asking about the care team experience, and understanding how care plans are built around the individual are equally important steps.

Finding care that goes beyond the rating

Star ratings reflect measurable outcomes, but they cannot fully capture what it feels like to receive consistent, attentive care at home. That is why understanding what an agency prioritizes — and how its teams are structured to deliver on it — matters just as much as the number beside their name.

Enhabit Home Health & Hospice builds care around both the clinical outcomes CMS measures and the personal experience of every patient and their loved ones. An interdisciplinary care team of skilled nurses, physical therapists, occupational therapists, speech-language pathologists, medical social workers and home health aides work together using evidence-based, disease-specific clinical pathways. This helps patients actively manage their own condition. Clinicians stay closely connected with patients and families throughout, so changes in condition are identified and addressed early rather than escalating into larger setbacks.

Hospice care ratings on Care Compare

Hospice care is also rated on Care Compare through a similar methodology used for home health agencies. Enhabit’s hospice services are designed to support patients, caregivers and loved ones with the same commitment to communication and coordinated care — providing physical, emotional and spiritual support for every patient living with a terminal illness, as well as bereavement support for families for at least 13 months after a patient’s passing.

For families navigating the transition from home health to hospice, Enhabit’s Care Connections Program helps ensure that transition happens with continuity, clear communication and the support patients and loved ones deserve. Care does not have to feel fragmented as needs evolve — and the right agency will make sure it does not.

Patients, caregivers and loved ones who begin this process by checking CMS star ratings are already taking an important step. Pairing those ratings with direct conversations, a clear understanding of services and a care team that communicates openly gives families the full picture they need to make a confident, informed decision — one that puts the well-being of the patient first.

To learn more about Enhabit’s home health and hospice services, visit enhabit.com.