When it comes to selecting a home health care agency, nurse Susan Sellechia, 34, says what matters most are compassion, education, and a drive to keep patients out of the hospital.
Her patient at Deer Meadows Home Health and Support Services, Joan Hutchins, 84, who was treated for ulcers on her legs, agrees.
"The nurses here have been very patient with me," said Hutchins. "I couldn't get any better care.
In July, Medicare instituted a five-star rating system to help consumers compare and select agencies.
Out of 9,000 agencies nationwide, only 239 received five stars, according to a Kaiser Health News analysis. Deer Meadows, in Northeast Philadelphia, was one of just eight agencies in Pennsylvania to receive the highest rating in the first quarter they were issued.
Home health care provides at-home services to people coming out of a hospital or a rehab facility who are entitled as part of their Medicare benefits to physical, occupational, or speech therapy at home.
Nationally, 3.4 million Medicare beneficiaries received home health services in 2014. Annually, Medicare spends about $18 billion on the home health care benefit.
To Stanley Rynkiewicz, administrator of Deer Meadows, the success of his agency comes down to a simple slogan: "Knowledge is power."
"Our staff likes to help people and likes to be educated," he said of his team, which works both at the Deer Park nursing facility and in clients' homes in the greater Philadelphia area.
He points out that they have seven wound-care specialists on staff, and ongoing certification training three or four times a year.
The Medicare ratings are based on nine criteria, ranging from how patients progress in care to immunization records and how soon patients receive care. At the end of the month, patient ratings will also be ranked and made available online.
To check out a particular agency, or to compare agencies, go to: www.medicare.gov/homehealthcompare. The site includes tips to help you find the right agency for your needs. Medicare has a similar rating system for nursing homes.
Locating the number of stars an agency received, however, can be tricky. From the home page, you can enter a specific agency or pick three in your area to compare. After hitting the search button, you'll reach a page with information about what services each agency offers. To find the star ratings, click "Quality of Care Information" - the middle tab - and scroll down.
Deer Meadows is currently rated 4.5 stars, having dropped a notch in the second quarterly round, released in October. Ratings are set on a curve, so changes reflect a facility's own performance as well as how it compares with others.
The next update will be posted Thursday.
Doris Peter, director of the Consumer Reports Health Ratings Center, has said the ratings are helpful but not ideal. Some of the data are self-reported by the agencies, and most agencies earn at least 3 stars.
"If you compare three providers at a time, you aren't likely to find a high or low performer," Peter told consumerreports.org. Rynkiewicz says the most important criterion in the ratings system is an objective measure: that home health care is delivered in a timely manner, no more than 24 to 48 hours after referral.
"Our goal is to improve people back to their former level of functioning," he said. "A fast response maximizes and reduces readmission to the hospital.
"It's like a one-two punch: The faster you're there, the more quickly you can calm someone down, reduce stress, and provide help as soon as possible.
" Not surprisingly, Rynkiewicz is a fan of the Medicare star system. Others say it's more complicated.
"The most important piece for consumers to understand is that star ratings for home health agencies are not like a hotel or restaurant star rating, where only four and five stars are good quality," said Jennifer Haggerty of the Pennsylvania Homecare Association.
"More than half of all home health agencies across the country fall in the middle, with 3 or 3.5 stars," said Haggerty. "Pennsylvania agencies continue to outperform others, scoring an average rating of 3.5 stars, higher than the national 3-star average."
Haggerty sees the ratings as giving lower-performing agencies something to strive for, particularly if reimbursement schedules are tied to performance in the future.
Joyce Gray, an aging-life-care professional in Philadelphia, thinks consumers should consider the star ratings.
"But what really matters is who walks into your home, their attitude, and how they get along with you," she said.
"You're often accessing care when you're quite sick and not interested in doing research."
Rynkiewicz also emphasizes that consumers should do their homework and not just accept a hospital recommendation.
"You have to remember that you have a choice," he said. "When you're in the hospital, they may say that because you're in my health system you should pick my agency. But choice is key - they're supposed to give people options to choose different agencies in the area."
Due to an earlier Medicare reform, hospitals have been penalized if patients are readmitted too soon after leaving the hospital, giving hospitals a major incentive to ensure that patients get proper care at home. Rynkiewicz said that since receiving the five-star rating, he had seen an uptick in referrals from hospitals to his agency.
"The most important thing is the need to treat people like human beings, not like a disease or a sickness," Rynkiewicz said. "And that's what we try to do."